Seguridad clínica y reclamaciones por responsabilidad profesional en Oftalmología / Clinical safety and professional liability claims in Ophthalmology

Introducción: La seguridad del paciente es una prioridad a nivel internacional. Las sociedades científicas y demás organizaciones en el campo de la Oftalmología han intensificado sus esfuerzos en materia de seguridad del paciente. Estos esfuerzos se han relacionado con la gestión del aseguramiento de la responsabilidad profesional médica mediante el análisis de las reclamaciones, como herramienta para aprender del error. Material y método: Revisión de la evolución en materia de seguridad clínica y responsabilidad profesional médica en la especialidad de Oftalmología. Resultados: La Oftalmología tiene una frecuencia elevada de reclamación y un riesgo elevado de indemnización en caso de producirse la reclamación. Determinadas reclamaciones, suscitadas por un error de cirugía o un defecto de información, tienen un riesgo especialmente elevado de indemnización y se precisa aumentar los esfuerzos para la prevención de estos eventos potencialmente evitables. El especialista en Oftalmología, como cualquier otro facultativo, está sujeto a la normativa legal vigente y una formación adecuada obligatoria en los aspectos médico-legales del ejercicio sería esencial. Conclusiones: Los profesionales deben tomar conciencia de los aspectos fundamentales de la responsabilidad profesional médica, así como aspectos específicos como la medicina defensiva o la seguridad del paciente. El conocimiento de estos aspectos médico-legales de la práctica clínica ayuda a allanar el camino hacia una carrera profesional satisfactoria y segura y ayuda a incrementar la seguridad del paciente. El objetivo de esta revisión es contribuir a esta formación en beneficio de pacientes y profesionales (AU)

Introduction: Patient safety is an international public health priority. Ophthalmology scientific societies and organisations have intensified their efforts in this field. As a tool to learn from errors, these efforts have been linked to the management of medical professional liability insurance through the analysis of claims. Material and methods: A review is performed on the improvements in patient safety, as well as professional liability issues in Ophthalmology. Results: There is a high frequency of claims and risk of economic reparation of damage in the event of a claim in Ophthalmology. Special complaints, such as wrong surgery or lack of information, have a high risk of financial compensation and need strong efforts to prevent these potentially avoidable events. Studies focused on pathologies or specific procedures provide information of special interest to sub-specialists. The specialist in Ophthalmology, like any other doctor, is subject to the current legal provisions and appropriate mandatory training in the medical-legal aspects of health care is essential. Conclusions: Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career, and help in increasing patient safety. The aim of this review is to contribute to this training, for the benefit of professionals and patients (AU)

Clinical safety and professional liability claims in Ophthalmology. / Seguridad clínica y reclamaciones por responsabilidad profesional en Oftalmología.

INTRODUCTION: Patient safety is an international public health priority. Ophthalmology scientific societies and organisations have intensified their efforts in this field. As a tool to learn from errors, these efforts have been linked to the management of medical professional liability insurance through the analysis of claims. MATERIAL AND METHODS: A review is performed on the improvements in patient safety, as well as professional liability issues in Ophthalmology. RESULTS: There is a high frequency of claims and risk of economic reparation of damage in the event of a claim in Ophthalmology. Special complaints, such as wrong surgery or lack of information, have a high risk of financial compensation and need strong efforts to prevent these potentially avoidable events. Studies focused on pathologies or specific procedures provide information of special interest to sub-specialists. The specialist in Ophthalmology, like any other doctor, is subject to the current legal provisions and appropriate mandatory training in the medical-legal aspects of health care is essential. CONCLUSIONS: Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career, and help in increasing patient safety. The aim of this review is to contribute to this training, for the benefit of professionals and patients.

[Benign concentric annular macular dystrophy]. / Distrofia macular anular benigna concéntrica.

CASE REPORT: A case of benign concentric annular macular dystrophy is described. A 32-year-old woman presented with loss of quality in visual acuity. Ophthalmologic examination, fluorescein angiogram, electrophysiologic tests and visual field measurements were performed. DISCUSSION: It is very important to include in the differential diagnosis other dystrophies which present a <> pattern on fluorescein angiography, given that preservation of relatively good visual acuity is a special feature of this disease.

Distrofia macular anular benigna concéntrica / benign concentric annular macular distrophy

Caso clínico: Presentamos un caso clínico de distrofia macular anular benigna concéntrica. Se trata de una mujer de 32 años que se presenta con pérdida de calidad visual. Se realiza exploración oftalmoscópica, angiografía fluoresceínica, pruebas electrofisiológicas y campimetría. Discusión: Es de gran importancia realizar un cuidadoso diagnóstico diferencial con otras distrofias que presenten un patrón angiográfico en «ojo de buey», dado que la conservación de una relativamente buena agudeza visual es una característica señalada de esta enfermedad

Case report: A case of benign concentric annular macular dystrophy is described. A 32-year-old woman presented with loss of quality in visual acuity. Ophthalmologic examination, fluorescein angiogram, electrophysiologic tests and visual field measurements were performed. Discussion: It is very important to include in the differential diagnosis other dystrophies which present a «bull’s eye» pattern on fluorescein angiography, given that preservation of relatively good visual acuity is a special feature of this disease

[Patient with severe corneal disease in KID syndrome]. / Paciente con enfermedad corneal severa en el contexto del síndrome kid.

CASE REPORT: A 33-year-old woman with superficial and deep bilateral corneal vascularization and keratoconjunctivitis sicca, keratoerythema and neurosensory deafness, was diagnosed with keratitis-ichthyosis-deafness (KID) syndrome. DISCUSSION: KID syndrome is a congenital ectodermal dysplasia characterized by the association of vascularizing keratitis, hyperkeratotic skin lesions and sensorineural hearing loss. Recently, limbal stem cell deficiency was recognized as a possible major pathogenetic factor.

Paciente con enfermedad corneal severa en el contexto del síndrome KID / Patient with severe corneal disease in KID syndrome

Caso clínico: Mujer de 33 años con neovascularizacióncorneal bilateral superficial y profunda yqueratopatía punteada superficial de distribucióndifusa, queratoeritema y sordera neurosensorial,que es diagnosticada de síndrome KID.Discusión: El síndrome KID es una displasia congénitaectodérmica caracterizada por la asociaciónde queratitis vascularizante, lesiones cutáneashiperqueratósicas y sordera neurosensorial. Recientemente,la deficiencia de stem cell limbares ha sidoreconocida como posible factor patogenético clave

Case report: A 33-year-old woman with superficial ;;and deep bilateral corneal vascularization and ;;keratoconjunctivitis sicca, keratoerythema and neurosensory ;;deafness, was diagnosed with keratitisichthyosis- ;;deafness (KID) syndrome. ;;Discussion: KID syndrome is a congenital ectodermal ;;dysplasia characterized by the association of ;;vascularizing keratitis, hyperkeratotic skin lesions ;;and sensorineural hearing loss. Recently, limbal ;;stem cell deficiency was recognized as a possible ;;major pathogenetic factor

[Light-induced maculopathy in cataract surgery]. / Ototraumatismo macular en cirugía de catarata.

CASE REPORT: Case 1: An 82-year-old man who underwent an uncomplicated phacoemulsification and IOL implantation (Tecnis Z 9000 lens) in his right eye under topical anaesthesia. Surgery lasted 14 minutes. Case 2: A 60-year-old woman with bilateral advanced primary open angle glaucoma who underwent an uncomplicated phacoemulsification and IOL implantation (Tecnis Z 9000 lens) in her right eye under peribulbar anaesthesia. Surgery lasted 36 minutes. One month after surgery both patients noted a para-central scotoma and impaired vision. Fluorescein angiography in both cases revealed retinal pigment epithelial changes compatible with intra-operative light-induced maculopathy. DISCUSSION: Light-induced maculopathy has been reported following cataract surgery. Whether physical properties of these new polysiloxane lenses contribute to retinal susceptibility to phototoxicity under certain light conditions needs to be elucidated.

Fototraumatismo macular en cirugía de catarata / Light-induced maculopathy in cataract surgery

Casos clínicos:Caso 1: varón de 82 años intervenido de catarata mediante facoemulsificación e implante de lente Tecnis® Z 9000 en su ojo derecho (OD), bajo anestesia tópica. La duración de la cirugía fue de 14 minutos sin complicaciones.Caso 2: mujer de 60 años con glaucoma primario de ángulo abierto (GPAA) bilateral avanzado, intervenida sin complicaciones de catarata mediante facoemulsificación e implante de lente Tecnis® Z 9000 en su ojo derecho, bajo anestesia peribulbar. La duración de la cirugía fue de 36 minutos.Al mes de la cirugía ambos pacientes evidenciaron escotoma paracentral inferior y escasa mejora de la agudeza visual (AV). La angiografía fluoresceínica (AGF) de ambos casos reveló cambios en el epitelio pigmentario de la retina compatibles con un posible fototraumatismo macular intraoperatorio.Discusión: La maculopatía por fototoxicidad es una complicación descrita tras cirugía de catarata.El que las propiedades físicas de estas nuevas lentes de polisiloxano favorezcan el fototraumatismo retiniano en determinadas condiciones lumínicas han de ser aclaradas (AU)

Case report: Case 1: An 82-year-old man who underwent an uncomplicated phacoemulsification and IOL implantation (Tecnis® Z 9000 lens) in his right eye under topical anaesthesia. Surgery lasted 14 minutes. Case 2: A 60-year-old woman with bilateral advanced primary open angle glaucoma who underwent an uncomplicated phacoemulsification and IOL implantation (Tecnis® Z 9000 lens) in her right eye under peribulbar anaesthesia. Surgery lasted 36 minutes. One month after surgery both patients noted a para-central scotoma and impaired vision. Fluorescein angiography in both cases revealed retinal pigment epithelial changes compatible with intra-operative light-induced maculopathy. Discussion: Light-induced maculopathy has been reported following cataract surgery. Whether physical properties of these new polysiloxane lenses contribute to retinal susceptibility to phototoxicity under certain light conditions needs to be elucidated (AU)

[Spherical aberration influence in visual function after cataract surgery: prospective randomized trial]. / Influencia de la aberración esférica en la función visual tras cirugía de catarata: ensayo prospectivo aleatorio.

PURPOSE: We compare the contrast sensitivity and visual acuity obtained with an anterior surface modified prolate intraocular lens (Tecnis Z9000) with the contrast sensitivity and visual acuity obtained with a standard acrylic foldable intraocular lens (Acrysof SA60 AT). METHODS: In this prospective trial, 64 patients presenting for cataract surgery were randomized to receive in both eyes either the Tecnis Z9000 intraocular lens or the the Acrysof SA60AT intraocular lens: 32 Tecnis Z9000 and 32 Acrysof SA60AT. Visual acuity and contrast sensitivity were monocular and binocularly tested in all of them preoperatively and three months after surgery. RESULTS: The Tecnis Z9000 intraocular lens provided statistically significantly better monocular (Tecnis group: 0.85; Acrysof group: 0.78; p < 0.01) and binocular (Tecnis group: 0.95; Acrysof group: 0.86; p < 0.02) visual acuity. The contrast sensitivity mean was also greater in Tecnis group in monocular and binocular conditions, but without statistical signification. CONCLUSION: Visual acuity and contrast sensitivity after cataract surgery improved in both groups. But monocular and binocular visual acuity was statistically significantly better only in Tecnis group. The contrast sensitivity mean values were greater in Tecnis group but without statistically significant differences.

Influencia de la aberración esférica en la función visual tras cirugía de catarata: ensayo prospectivo aleatorio / Spherical aberration influence in visual function after cataract surgery: prospective randomized trial

Propósito: Comparar los resultados obtenidos tras la implantación de una lente con óptica prolata modificada (Tecnis Z9000) con los de una lente plegable acrílica convencional (Acrysof SA60 AT) en cuanto a agudeza visual y sensibilidad al contraste.Métodos: En este estudio prospectivo 64 pacientes fueron aleatorizados para recibir en sus dos ojos el mismo tipo de lente intraocular: 32 Tecnis Z9000 y 32 Acrysof SA60AT. La agudeza visual y sensibilidad al contraste se evaluó monocular y binocularmente en todos ellos antes de la cirugía y a los tres meses de evolución.Resultados: La agudeza visual monocular fue mejor en el grupo Tecnis (0,85) que en el Acrysof (0,78) (p<0,01). En condiciones de binocularidad también resultó superior la AV en el grupo Tecnis (0,95) que en el Acrysof (0,86) (p<0,02). La sensibilidad media al contraste también es superior para el grupo Tecnis tanto monocular como binocularmente pero no alcanza significación estadística.Conclusión: En ambos grupos se produjo una mejoría de la agudeza visual y sensibilidad al contraste después de la cirugía de catarata pero el implante Tecnis se asoció con una agudeza visual significativamente mejor tanto monocular como binocularmente. Los valores medios de sensibilidad al contraste son superiores en el grupo Tecnis pero la diferencia no es estadísticamente significativa

Purpose: We compare the contrast sensitivity and visual acuity obtained with an anterior surface modified prolate intraocular lens (Tecnis Z9000) with the contrast sensitivity and visual acuity obtained with a standard acrylic foldable intraocular lens (Acrysof SA60 AT).Methods: In this prospective trial, 64 patients presenting for cataract surgery were randomized to receive in both eyes either the Tecnis Z9000 intraocular lens or the the Acrysof SA60AT intraocular lens: 32 Tecnis Z9000 and 32 Acrysof SA60AT. Visual acuity and contrast sensitivity were monocular and binocularly tested in all of them preoperatively and three months after surgery.Results: The Tecnis Z9000 intraocular lens provided statistically significantly better monocular (Tecnis group: 0.85; Acrysof group: 0.78; p<0.01) and binocular (Tecnis group: 0.95; Acrysof group: 0.86; p<0.02) visual acuity. The contrast sensitivity mean was also greater in Tecnis group in monocular and binocular conditions, but without statistical signification.Conclusion: Visual acuity and contrast sensitivity after cataract surgery improved in both groups. But monocular and binocular visual acuity was statistically significantly better only in Tecnis group. The contrast sensitivity mean values were greater in Tecnis group but without statistically significant differences

[Acute posterior multifocal placoid pigment epitheliopathy associated with Graves-Basedow's disease]. / Epiteliopatía pigmentaria placoide multifocal posterior aguda asociada a enfermedad de Graves-Basedow.

CLINICAL CASE: We present a case of a 40-years-old woman with an acute posterior multifocal placoid pigment epitheliopathy (APMPPE) associated with recent instauration hyperthyroidism symptoms. A Graves' disease was diagnosed and the patient was initially controlled with antithyroid drugs. The epitheliopathy evolution was relatively favourable without relapse. Two years later a thyroidectomy was performed. DISCUSSION: We have not found in the literature any APMPPE case associated with Graves' disease. We only found an APMPPE case associated with a subacute thyroiditis. Little is known about the APMPPE causes, it could be that placoid epitheliopathy and Graves' disease had a common autoimmune origin. We can not forget that our finding could be only a matter of chance.

Epiteliopatía pigmentaria placoide multifocal posterior aguda asociada a enfermedad de graves-basedow / Acute posterior multifocal placoid pigment epitheliopathy associated with graves-basedow's disease

Caso clínico: Paciente mujer de 40 años de edad que presentó una epiteliopatía pigmentaria placoide multifocal posterior aguda (EPPMPA) asociada a un cuadro de hipertiroidismo de instauración reciente. La paciente fue diagnosticada de enfermedad de Graves y fue controlada inicialmente con tratamiento antitiroideo. La epiteliopatía evolucionó de forma relativamente favorable sin recidivas. A los dos años se practicó tiroidectomía subtotal. Discusión: No hemos encontrado en la bibliografía ningún caso de EPPMPA asociada a enfermedad de Graves. Sólo hallamos un caso de EPPMPA asociada a una tiroiditis subaguda. Poco se conoce sobre las causas de la EPPMPA, podría ser que la epiteliopatía placoide y la enfermedad de Graves tuvieran un origen autoinmune común. No podemos descartar la posibilidad de que nuestro hallazgo sea sólo casual (AU)