Post-operative Care and Follow-up After Cataract Surgery: Where Systems Commonly Fail
- ijeeva
- Jan 5
- 3 min read
In cataract litigation, the focus is often placed on the operation itself. In practice, many successful claims arise not from what happened in theatre, but from what occurred, or failed to occur, afterwards.
This blog is written for surgeons, medical experts, and those involved in medico-legal analysis. It explores how post-operative care and follow-up are examined by the court, and why apparently minor omissions after surgery can have disproportionate medico-legal consequences.
Cataract Surgery Does Not End in Theatre
From a medico-legal perspective, cataract surgery is a continuum. The duty of care extends beyond the operation to include post-operative assessment, monitoring, and timely response to complications.
Courts do not view post-operative care as an optional adjunct. They examine whether reasonable steps were taken to identify and address foreseeable risks in the days and weeks following surgery.
Early Post-operative Review: A Critical Safeguard
The immediate post-operative period carries recognised risks, including raised intraocular pressure, wound-related issues, inflammation, and early infection.
Litigation commonly arises when:
post-operative review is delayed or omitted
symptoms reported by the patient are not taken seriously
abnormal findings are not escalated
safety-netting advice is unclear or undocumented
Expert witnesses are frequently asked to assess whether earlier review would likely have altered the outcome.
Responding to Post-operative Symptoms
Patients are often advised that mild discomfort is normal after cataract surgery. Difficulty arises when this reassurance leads to under-recognition of significant symptoms.
Courts scrutinise responses to complaints such as:
increasing pain
reduced vision
redness or discharge
photophobia
sudden change in visual quality
Failure to reassess promptly may be interpreted as a missed opportunity to intervene.
Endophthalmitis and Time-critical Response
Few complications carry greater medico-legal weight than endophthalmitis. While rare, its consequences can be catastrophic, and outcomes are closely linked to the speed of diagnosis and treatment.
Expert analysis often focuses on:
whether warning symptoms were recognised
whether same-day assessment was arranged
whether treatment was initiated promptly
whether referral pathways were clear and accessible
Delay of even hours may be scrutinised in retrospect.
Raised Intraocular Pressure and Early Complications
Transient pressure elevation is common after cataract surgery, particularly in eyes with pre-existing glaucoma or pseudoexfoliation. Problems arise when pressure rises are not detected or addressed.
Claims may involve:
failure to measure intraocular pressure
inadequate follow-up in high-risk patients
delayed recognition of pressure-related visual loss
Courts consider whether risk stratification influenced follow-up planning.
Follow-up Planning and Handover Failures
Post-operative care is increasingly shared between surgical units, optometry, and community services. This introduces system-level vulnerabilities.
Medico-legal scrutiny often centres on:
unclear responsibility for follow-up
missed appointments without recall
inadequate communication between providers
lack of clarity about escalation pathways
Experts must consider whether systems were sufficiently robust to ensure patient safety.
Documentation and Safety-netting
In litigation, documentation becomes the primary evidence of what advice was given and what actions were taken.
Common deficiencies include:
absence of documented warning signs
lack of written advice
no record of escalation instructions
unclear follow-up plans
When safety-netting is not documented, courts may assume it was not provided.
Causation and Preventability
Post-operative cases often turn on whether earlier recognition or intervention would have prevented harm.
Experts are asked to consider:
whether deterioration was predictable
whether earlier review would likely have changed the outcome
whether harm was avoidable or inevitable
This analysis requires careful separation of complication from negligence.
Teaching Point for Surgeons and Experts
Post-operative care fails medico-legally not because complications occur, but because responses to risk are delayed, fragmented, or poorly documented.
For surgeons, clear follow-up pathways and robust safety-netting reduce risk.For expert witnesses, understanding post-operative systems is essential to assist the court objectively.
Conclusion
Post-operative care and follow-up are central components of safe cataract practice and frequent focal points in litigation. Courts look beyond surgical skill and examine whether patients were monitored, supported, and responded to appropriately after surgery.
When post-operative pathways are clear, responsive, and well documented, outcomes are more defensible and patient harm is more likely to be minimised. Understanding this perspective is essential for clinicians and expert witnesses involved in cataract-related medico-legal work.
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