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Showing contexts for: cataract in R. K. Tripathi vs Dr. Ashok Pachori & Anr . Ltd on 3 January, 2018Matching Fragments
2. Being aggrieved by the sufferings the complainant alleged medical negligence committed by the OP, Dr. Ashok Pachori as implanted ACIOL without removing his injured lens resulting into damage to the retina of his right eye, filed a complaint before the Uttar Pradesh State Consumer Disputes Redressal Commission (in short, "the State Commission")
3. The OP resisted the complaint by filing written version and submitted that he examined the complainant and found that there was a posterior sub luxation of lens in the right eye due to blunt trauma. The lens was dislocated laterally and inferiority, also there was vitreous herniating in anterior chamber. Hence, OP had planned for Intra Capsular Cataract Extraction (ICCE) on 21-12-1999 with A.C. Intra Occular Lens (IOL). The OP denied any negligence on the part of treatment of the blunt injury. The OP further submitted that he has tried to remove overlying vitreous with cellulose spunge, but it was not possible. Also anterior vitrectomy was done removing it by doing all these lens dipped into vitreous, as Zonules were very weak. However, papillary area was clear. He has performed to remove vitreous from anterior chamber and to ensure clear and better vision ACIOL was implanted. The same was informed to the complainant and was asked to come for regular follow up, but complainant never came after 22-12-1999 for follow up treatment or checkup.
6. Learned counsel for the complainant placed reliance upon literature on cataract surgery and the textbook of Opthalmology which has discussed about aphakia. The absence of the lens from its normal position is quite aphakia. Therefore, surgical removal of cataractous lens is by far the commonest cause of aphakia. Under such circumstances, the management is discussed as below:
"The management of dislocation of lens requires meticulous evaluation of an individual case. If the subluxated lens is clear and does not cause any symptom, spectacle correction is advised; an aphakic correction gives better visual acuity than the phakie. The dislocated lens in the anterior chamber should be removed as early as possible to prevent PAS formation. In the posterior dislocation of the lens, an aphakic correction is prescribed. No attempt should be made to fish out the lens from the vitreous cavity as it ends up in gross vitreous loss and poor vision. The accompanied iridocyelitis is treated with atropine, antibiotic and steroids. The subluxated cataractous lens can be dealt with pars plana lensectomy with good visual prognosis."
(i) severe impairment of visual acuity; (ii) lens dislocation into the interior chamber; and (iii) phacolytic glaucoma; (iv) phacoantigenic ubeitis, etc..
8. Therefore, under these circumstances, the OP took a decision of surgery for implanting the artificial lens inside the eye post operatively 20% mannintol intravenously to reduce vitreous volume. But, the doing all these things, the lens moved further in the vitreous and it was not safe to remove the same at that point of time. Thus, the OP doctor had only two options, either to close the case without putting the lens or putting the lens in A.C. to have good vision so that complications should not occur and remove the soft cataractous lens later on with pars plana technique.
9. I have perused the medical record and the relevant medical text, the research papers on the ocular injuries and given thoughtful consideration to the arguments advanced by the learned counsel for both the parties. It is an admitted fact that there was a blunt trauma to the right eye of the complainant and it was the case of posterior subluxation of the lens in the vitreous chamber. It is clear from the multiple prescriptions that before consulting OP1 the complainant consulted several doctors in Kanpur, Allahabad, Lucknow, etc.. Everyone has advised that the injured lens be removed and further treatment to be taken by implantation of IOL. As per medical record and submissions made by OP, it is clear it was posteriorly dislocated cataract lens in the right eye and it was admitted fact that OP had made his conscious efforts to take out the lens from vitreous but it was failed. The OP had tried to extract the lens by means of cryoprop, but it was not freezing the upper pole of lens but overlying vitreous starting freezing. But despite all these procedures the lens dipped into vitreous as zonules were very weak. Therefore, the OP performed anterior vitrectomy and removed the vitreous from anterior chamber and, thereafter, ACIOL was implanted.