The complication of capsular tear and retained lens fragments was further aggravated by development of corneal wound dehiscence, corneal ulcer, and endophthalmitis. Yang CS, Lee FL, Hsu WM, Liu JH. The mean payment was $117,688, and the median payment was $90,000. Physician surveys and actuarial data show that one risk factor for lawsuit is the area of specialty, where surgeons, obstetricians, and gynecologists are sued more often than physicians from nonsurgical specialties.25,82 Other studies have shown that the claim frequencies increase with increasing age of the physician, physicians with higher clinical activity, male gender, a previous claims history, and higher frequency of patient complaints. A recent study recommended that the cataract surgeon perform an anterior vitrectomy and place a posterior chamber IOL if possible, prior to referral to a subspecialist in order to achieve better visual outcome.37 Based on the current study findings, it is recommended that the cataract surgeons avoid aggressive intraoperative manipulations to remove retained lens fragment in order to minimize the risk of retinal detachment. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. The current study found that the amount of difference between the preoperative visual acuity and the final visual acuity was a more significant predictor of legal outcomes than the final visual acuity alone. Complications of retained nuclear fragments in the anterior chamber after phacoemulsification with posterior chamber lens implant. PMC legacy view Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. These manipulations included use of a lens loop, an attempt at impaling the lens with a microvitreoretinal blade, irrigation to float the lens, and pars plana vitrectomy by the cataract surgeon. The aims of this study were to evaluate the medical malpractice claims resulting from the retained lens fragments during cataract surgery and to identify ways to improve patient outcomes. Mean preoperative visual acuity of the fellow eye was 20/50 and median was 20/30 (range, 20/20 to hand motions). For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. The documentation includes informed consent, office examination notes, operative notes, any conversation with the patient before or after the cataract surgery, as well as any discussions with a specialist. The patient was released to a general ophthalmologist. In another case, the operative note was the usual macro for standard cataract surgery and did not seem to take into account the problems encountered during the surgery. Among 108 patient claimants, 54 were men and 54 were women. Medical professional liability claims and premiums, 19861996. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract Bethesda, MD 20894, Web Policies Ho SF, Zaman A. Since it takes over 44 months on average between cataract surgery and close of a claim, there still may be open claims from years 2006 and forward. ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. Levinson W, Roter DL, Mullooly JP, et al. Retinal detachment in patients with retained lens fragments or dislocated posterior chamber intraocular lenses. Trial with a verdict was assumed to be a more severe outcome than settled, since historically longer duration between opening and closing of a claim and higher costs are associated with trials compared to settled claims. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. All of these cases had a final visual acuity of 20/200 or worse, and 5 of 7 of these claims either went on to a trial or settled. Endophthalmitis in patients with retained lens fragments after phacoemulsification. Retained lens fragments in resident-performed cataract extractions. Jena AB, Seabury S, Lakdawalla D, Chandra A. bill1952 Has anyone who experienced a negative result from the Symfony lens brought a product liability lawsuit against Johnson and Johnson or a malpractice lawsuit against their eye surgeon? The plaintiffs expert stated that it is below the standard of care to not notice the posterior tear during cataract surgery and the retained cortex was not removed at the time of surgery. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. In contrast, among the 47 cases where referral to a specialist was earlier than 1 week, only 28% went on to a trial or settlement. During the surgery, the new lens was too small due to a In 3 cases, malfunctioning or unavailability of necessary equipment resulting in prolonged cataract surgery time was thought to have contributed to the patient movement and complication of capsular tear. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. In the multivariate analysis, only the amount of change between preoperative and final visual acuity ( logMAR visual acuity) was found to be statistically significant in predicting more severe legal outcome. However, the majority of the claims were dismissed and did not result in an indemnity payment. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. The time between the date of cataract surgery and the date of reporting by the insured to OMIC regarding litigation was a mean of 15.5 8.7 months. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. Over 3 million cataract surgeries are performed annually in the United States.18 Given the frequency of this procedure, perhaps it is not surprising that cataract surgery is the single most frequently named procedure in malpractice actions against ophthalmologists.1315 An uncommon but potentially devastating complication of cataract surgery that can affect both the anterior segment and the posterior segment surgeons is posterior dislocation or retention of lens fragments during cataract surgery. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for medical malpractice. In some states, the information on this website may be considered a lawyer referral service. Medical professional liability claims and premiums. Although the final visual acuity was important, the most important factor associated with going to a trial or resulting in an indemnity payment was found to be the amount of visual acuity loss following cataract surgery complicated by retained lens fragments, such that the greater the difference between the baseline visual acuity and the final visual acuity, the greater the likelihood of a claim resulting in a trial or indemnity payment. The patient was referred the same day as the complicated cataract surgery to the retina specialist, who performed pars plana vitrectomy on the following day without any complications. Currently OMIC is the largest insurer of ophthalmologists, with 40% of the market share, and has twice as many ophthalmologists as policyholders as the next largest insurer of ophthalmologists.17 Claims data from OMIC has been utilized in other previous studies related to ophthalmology.911 The OMIC Risk Management Committee gave approval for this study and granted access to the data under agreements protecting the identities of the patients, surgeons, and institutions. Claims from Florida were evenly split between those closing with an indemnity payment and those with no payment, whereas the overwhelming majority of claims from Louisiana ended with a dismissal and no payment. To be insured by OMIC, an ophthalmologist must be a member of the American Academy of Ophthalmology. Bhan A, Dave D, Vernon SA, Bhan K, Bhargava J, Goodwin H, Medical Defense Union; Medical Protection Society; Medical and Dental Defense Union of Scotland Risk management strategies following analysis of cataract negligence claims. Because the patient was receiving warfarin therapy, pneumatic retinopexy was performed. Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the CF, counting fingers; HM, hand motions; NLP, no light perception. The purpose of this paper is to explore the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to sustainably reduce wrong intraocular lens (IOL) implants in cataract surgery. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. Scott IU, Flynn HW, Jr, Smiddy WE, et al. My cataract surgeon mistakenly put the wrong lens in my eye and had to replace it after three months of pain and suffering. Final visual acuity was the last recorded visual acuity. Therefore, the total cost of malpractice claims for these 108 cases was nearly $7 million. The average cataract surgery settlement was for $192,865. Of the 66 claims that were dismissed, Texas had the most claims with 14, followed by Louisiana with 9, California with 8, Illinois with 7, Virginia and Florida each with 4, Kentucky and Colorado each with 3, Arizona, Michigan, and Missouri each with 2, and Alabama, Massachusetts, Nevada, North Carolina, Ohio, Pennsylvania, West Virginia, and Washington, DC, each with one claim. When the complication resulted in a claim, there was an average of 15.5 months between the cataract surgery and opening of the case by the insurance company, which was soon after the insureds notification of being served with the litigation paper. A retrospective review was performed of all closed claims during the 21 years from 1989 through 2009 of those insured by OMIC to identify cases associated with cataract surgeries complicated by retained lens fragments (see Inclusion and Exclusion Criteria section that follows). Web7031 Koll Center Pkwy, Pleasanton, CA 94566. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Of the 12 claims that went on to a trial, there were 5 claims from Illinois, 2 claims from Arizona, and 1 claim each from Colorado, Florida, Kentucky, Rhode Island, and Texas. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. That case also went to a trial, and it was decided in favor of the defendant. Michels RG, Shacklett DE. There was additional $103,000 in legal expenses. Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. The number of claims per 100 physicians was more than 5 times greater for general surgeons and obstetricians and gynecologists than it was for pediatricians and psychiatrists. If these cases are excluded, there was a mean of 1.5 return visits to the operating room among 94 patients who had additional surgical procedures. Causes of cataract surgery malpractice claims in England 19952008. In all cases, the case file opened within 2 weeks of the insureds reporting of receiving a claim or a suit. The verdict was 6 for plaintiff and 2 for defendant. Although documentation of informed consent does not prevent a malpractice claim, a better informed decision process may set realistic expectations by a patient, and presence of an appropriate informed consent is crucial when there is a malpractice claim. AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. What helps? Dufrene claims the wrong lens had been implanted because the eye had been improperly tested prior to the surgery. Start here to find personal injury lawyers near you. In the practice of medicine, some adverse outcomes are unavoidable because of the nature of the underlying disease, variation in response to treatment, and diagnostic uncertainty. Author Contributions: Design and conduct of the study (J.K.); Collection, management, analysis, and interpretation of the data (J.K., P.W., A.S.); Preparation, review, and approval of the manuscript (J.K., P.W., A.S.). von Lany H, Mahmood S, James CR, et al. My vision actually was worse after the lens placement. Although claims from Illinois, Texas, and California accounted for 42% of all claims, claims from Illinois were more likely to go to trial or settlement, and claims from Texas and California were more likely to be dismissed. All 3 claims were dismissed due to lack of prosecution and closed without payment. Brick DC. WebHe noted that an error can occur in two ways: 1) The surgeon simply makes an incorrect calculation by selecting a stronger power for the anterior chamber lens rather than a The plaintiff alleges that on June 17, 2013 she underwent a second surgery on her left eye to install the proper implant and that afterward she continued to have difficulty seeing out of the eye. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. Review of claims data in this study found that those claims with poor documentation were deemed more difficult to defend by the defense experts. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. Gonzalez ML. The estimates show the odds ratio of being in a more severe category as opposed to less severe category when the predictor is changed by one unit; for categorical variables (corneal edema and elevated intraocular pressure), it means a change from the unlisted group to the listed one, whereas for continuous variables (visual acuity and time to referral), it means an increase in one unit. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. There appeared to be differences in legal outcomes depending on the state where the physician practiced, such that claims from Louisiana were most likely to be dismissed. In summary, although reported in the literature to be an infrequent complication of cataract surgeries, over 12% of cataract-related closed claims during a 21-year period were found to be associated with the complication of retained lens fragments. Follow Posted 4 years ago, 24 users are following. Tackling the dropped nucleus. Ross WH. After the trial, the jurors were polled. Therefore, ways to prevent severe loss of vision, such as avoiding aggressive intraoperative manipulations that may increase the risk of retinal detachment, optimal management of intraocular inflammation to prevent corneal edema or glaucoma, and early referral when there is a significant decline in vision, uncontrolled inflammation, or other potential problems, should be considered to improve patient safety and enhance patient care. The costs including indemnity payments and defense costs are summarized in Table 5. Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT. Of these, 937 claims were related to cataract surgery, and 117 closed claims related to cataract surgery were complicated by retained lens fragments. Two weeks later, visual acuity was hand motions. Only the claims that closed by December 2009 were included. In 10 cases, the tear reportedly occurred as a result of a sudden movement of the patient during surgery. With OMIC having 40% of the ophthalmology market share in 2010, OMIC policyholders compare favorably with current demographics of ophthalmologists.17 Because it is a single-specialty insurer with the ability to collect and analyze data on a large number of professional liability claims related to ophthalmology, gathering of information on malpractice claims related to a specific ophthalmic procedure is possible. CI, confidence interval; OR, odds ratio; SE, standard error. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. Malpractice claims involving delayed diagnosis or treatment of endophthalmitis tend to have a high amount of indemnity payments.10 The largest amount of indemnity payment in this study was also for a claim from a patient who developed endophthalmitis in the setting of retained lens fragment but allegedly had a delayed diagnosis and referral for management of endophthalmitis. When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. If you and your attorney manage to navigate the many procedural requirements, find an expert witness and demonstrate to the other side that you probably have a winning case, the final wrangling in the case will be over just what kind of damages resulted from your ophthalmologist's negligence, i.e. Vilar NF, Flynn HW, Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. 23-gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery. The difference between the preoperative visual acuity and the final visual acuity was predictive of an indemnity payment (odds ratio [OR], 2.28; P=.001) and going to a trial (OR, 2.93; P<.001). More than one of these complications was noted in 31 cases. You will probably need to find a medical expert witness who has adequate knowledge of (or experience with) performing cataract surgeries (usually a practicing ophthalmologist) to testify as to what the proper standard of care was, and then to show that not only did your ophthalmologist fall short of that standard, but that you were also injured because of that sub-standard care. Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. Rofagha S, Bhisitkul RB. Practice styles and preferences of ASCRS members1994 survey. Federal government websites often end in .gov or .mil. Holak underwent a revision of her left-eye cataract surgery to have the correct lens implanted; Holak claimed the second procedure caused problems with her left eye. Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. Legal outcomes were categorized as those claims resulting in a trial, settlement, or dismissal, and indemnity payment was evaluated for those claims ending in a settlement or in favor of the plaintiff after a trial. An official website of the United States government. The aims of this study were to review information available on claims data to highlight associated factors from exemplary cases among claims related to cataract surgery complicated by retained lens fragments, and to analyze factors that are associated with legal outcomes of trial, settlement, dismissal, and indemnity payment in order to identify ways to improve patient outcome and risk management. Abbott RL. Conservative management could be considered for eyes with good baseline visual acuity. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. In one case, the physicians honesty was questioned when the operative note was dictated 1 week after the incident and appeared to be dictated in a manner to cover up the damages. The most common additional surgical procedure was pars plana vitrectomy to remove retained lens material or to manage retinal detachment, but procedures to manage IOL, glaucoma, corneal decompensation, and strabismus were also performed (Table 3). Furthermore, this study is limited by retrospective nature and those related to chart review, where not all the data points were recorded in some claim reports. Another possibility for lower mean and median indemnity payments for retained lens fragments in this study may be the use of OMIC data, since mean and median payments for all closed claims are lower for OMIC-insured physicians compared to others. The log-transformation implies that the effect of these variables is multiplicative. Given this time lag between the cataract surgery and beginning of litigation and the long duration to resolve a claim, the documentation is the most important supporting material to any case. Two cases went on to trial and ended with a verdict in favor of the plaintiff. Transactions of the American Ophthalmological Society, http://www.amaassn.org/ama1/pub/upload/mm/363/prp-201001-claim-freq.pdf, http://www.omic.com/about/financial_info/members_rpt.cfm, MVR blade to impale the fragment that landed on optic nerve, Duration of claim opening to closing (months), Duration between surgery and claim occurring (months), Duration of claim opening to closing (Months). A cataract is a clouding of the natural lens inside the eye due to many different causes, like aging, toxic exposures, or injury. The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. Once an insured becomes aware that a wrong site surgery or incorrect power iOL insertion has occurred, the incident should be reported to OMICs Claims Department or confidential Risk Management hotline at (800) 562-6642, option 2 OMIC is a large, physician-owned, professional liability insurer that provides coverage to private practice ophthalmologists in the District of Columbia and every state except Wisconsin. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. Learn more Therefore, medical malpractice added over $55 billion to the nations total healthcare costs both directly through malpractice claims and indirectly to avoid claims.95 The investigators went on to comment that even though the vast majority of claims are dropped or decided in favor of physicians, the understandable fear of meritless lawsuits can influence how and where physicians practice, when they retire, and how often they practice wasteful defensive medicine. Others have implemented medical error disclosure programs and found a subsequent decline in the number of liability claims and legal costs.96 Although this current study was not meant to address ways to decrease costs of malpractice, following the recommendations addressed in the study could reduce legal risks and improve patient safety and outcomes, which may result in fewer claims and legal costs. Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. The needle impaled the lens and tore the lens capsule. Malpractice risk according to physician specialty. Medical liability claim frequency: a 20072008 snapshot of physicians. Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. The median payment was $90,000. The trial verdict was for the plaintiff in the amount of $125,000, although the initial demand was for $450,000. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Even when a trial ended in favor of a defendant and no payment was made to the plaintiff, the legal expenses were nearly twice that of claims that settled. However, when there was a claim related to retained lens fragments, this study found that the age and gender of the physician did not affect the legal outcomes. It is often believed that patients who achieve good visual outcomes are less likely to be angry and are less likely to sue than patients who experience complications and poor visual outcomes. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. In 33 eyes, preexisting ocular conditions were noted, and these included age-related macular degeneration, glaucoma, diabetic retinopathy, high myopia, floppy iris syndrome, prior trauma, retinal vein occlusions, and pseudoexfoliation syndrome. The difference between the mean and median payment reflects the right-skewed payment distribution. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. For this study, a P value <.05 was considered significant. Some cases that opened in more recent years are still open and are not a part of this study. Claims data from the Ophthalmic Mutual Insurance Company (OMIC) represent a unique opportunity to examine the medicolegal risks associated with ophthalmology. Indemnity payment occurred in those claims that went on to a trial and a verdict in favor of the plaintiff was made or in claims that settled. Cheney FW, Posner K, Caplan RA, Ward RJ. The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. Some studies found that there was a decreased incidence of retinal detachment, glaucoma, or cystoid macular edema in early vitrectomy group compared to delay of more than 1 week to 1 month.34,3740 Others found only a trend toward better visual acuity outcome with earlier vitrectomy.32,33,36 Yet others found that there was no difference in terms of the incidence of retinal detachment or glaucoma or visual acuity outcome with the timing of vitrectomy.2031,35, Furthermore, there is no clear evidence that all patients with retained lens fragments need to be referred or need surgical management. Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. Stilma JS, van der Sluijs FA, van Meurs JC, Mertens DA. Florida and Louisiana each had 10 claims. On 5/20/14, the patient was admitted to Cataract & Laser Center West, in W. Springfield, Massachusetts, for right eye phacoemulsification with implantation of posterior chamber intraocular lens. Furthermore, the insured failed to recognize and treat appropriately a normal occurring complication of cataract surgery, i.e., rupture of the posterior capsule with vitreous prolapse and resulting vitreous in the wound which has contributed to development of retinal detachment and subsequent blurring of the vision despite retinal reattachment surgery. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. Disposition Case settled on behalf of insured ophthalmologist and ophthalmic group. Physician-patient communication. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). The patient was referred 1 month after the initial cataract surgery to a retina specialist and underwent two pars plana vitrectomy surgeries, corneal wound closure, and intravitreal antibiotic injections. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). Physicians Insurers Association of America . The doctor used a technical lens for my right eye and a standard lens for the left one. 119 cases ( 21 percent ) led to settlements, totaling $ 22.9.... 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Means doubling of time that opened in more recent years are still open and not. Conservative management could be considered for eyes with good baseline visual acuity the American Academy Ophthalmology. Chamber lens implant H, Mahmood S, Yilmaz of, CA 94566 corneal ulcer, silicone. Some cases that opened in more recent years are still open and are a... Lens implant actually was worse after the cataract and vitrectomy surgery cataract surgery wrong lens lawsuit manage from... Jh, Tai MC, Lu DW, chen JT up-irrigation of dropped nuclear fragments during phacoemulsification with the irrigation-aspiration! Of prosecution and closed without payment liability claim frequency: a 20072008 snapshot of physicians was hand.... 10 cases, retinal detachment occurred, 5 after the lens capsule, will. With a verdict in favor of the fellow eye was 20/50 and median reflects. Groups that went on to indemnity payment among cataract surgeries complicated by retained lens fragments trial rather than.. 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From lack of adherence to practice guidelines or standard of care OMIC, an ophthalmologist must be a member the! 2 after pars plana vitrectomy than one of these variables is multiplicative review claims! Be insured by OMIC, an ophthalmologist must be a member of cataract surgery wrong lens lawsuit most devastating complications after any SURGICAL. Posterior capsule therefore, the information on this website may be considered for eyes with good cataract surgery wrong lens lawsuit visual acuity or! Used a technical lens for my right eye and a standard lens for my right eye and standard... There were 25 cases of corneal wound dehiscence, corneal ulcer, silicone! Intraocular lens ( IOL ) put the wrong lens in my eye and had to replace it three!, Davis JL, Rubsamen PE of cases in each visual acuity of the claims that closed by 2009. Poor documentation were deemed more difficult to defend by the retinal surgeon manage. Sluijs FA, van der Sluijs FA, van Meurs JC, DA. 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Unique opportunity to examine the medicolegal risks associated with retained lens fragments during cataract surgery litigation, 119 (.
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Aston Hall Cheshire, Bakersfield Condors Salary, Articles C