Choroidal Hemorrhage Following Paracentesis in a High-Risk Patient
Choroidal Hemorrhage Following Paracentesis in a High-Risk Patient
Expert analysis addressed whether performing a paracentesis on a high-risk patient was appropriate and whether the failure to treat or refer for the resulting choroidal hemorrhage constituted a breach of the standard of care.
Case Summary
Evaluated a case in which a patient with multiple cardiovascular risk factors developed a choroidal hemorrhage immediately following a paracentesis performed to manage elevated intraocular pressure, ultimately resulting in the loss of all useful sight.
Background
Mr. X had previously undergone cataract surgery complicated by vitreous loss and subsequent placement of an anterior chamber IOL. He developed elevated intraocular pressure (IOP) postoperatively. On post-operative day 11, with IOP significantly elevated, a paracentesis was performed. Immediately following the procedure, Mr. X experienced severe ocular pain. He had significant risk factors for choroidal hemorrhage, including atherosclerotic cardiovascular disease (ASCVD), hypertension, and glaucoma. He was not appropriately treated or referred following the event, resulting in permanent and total loss of useful vision.
Expert Analysis
- Review of surgical and post-operative records
- Assessment of the decision to perform paracentesis given the patient’s known risk profile
- Evaluation of whether pre-procedural risk stratification was appropriately conducted
- Analysis of the presenting signs and symptoms consistent with choroidal hemorrhage
- Review of post-procedure management and timeliness of intervention or referral
- Assessment of causal relationship between the paracentesis and the resulting vision loss
Testimony Provided
Provided expert opinion on whether the paracentesis should have been performed given the patient’s significant risk factors and whether the failure to appropriately treat or refer for the resulting choroidal hemorrhage fell below the standard of care.