Ocular Anesthesia-Related Closed Claims from Ophthalmic Mutual Insurance Company 2008–2018

Published:December 25, 2019DOI:https://doi.org/10.1016/j.ophtha.2019.12.019


      To evaluate the types of anesthesia-related closed claims and their contributing factors, using data from the Ophthalmic Mutual Insurance Company (OMIC).


      Retrospective analysis of preexisting data.


      Plaintiffs who filed a professional liability claim or suit (written demand for money) against OMIC-insured ophthalmologists, ophthalmic practices, or surgicenters in which the surgical case occurred.


      Plaintiff claims were collected from the OMIC database from 2008 to 2018 using search queries for terms associated with known complications of ophthalmic anesthesia.

      Main Outcome Measures

      Number and types of anesthesia-related injuries and claims, who administered the anesthesia, the outcomes of the claim or suit, cost to defend, and payments made to plaintiffs.


      Sixty-three anesthesia-related claims or suits were filed by 50 plaintiffs. Anesthesia-related injuries included globe perforation (n = 17), death (n = 13), retrobulbar hemorrhage (n = 7), optic nerve damage (n = 4), vascular occlusions (n = 2), pain (n = 2), eye or head movement resulting in injury (n = 2), and 1 case each for numbness, diplopia, and tooth loss during intubation. All but 1 patient who died had preexisting, significant comorbidities. Two deaths were related to brainstem anesthesia. Regarding the type of anesthesia in the closed claims, retrobulbar and peribulbar anesthesia were the most common types (n = 16 each), followed by local infiltration around the lids and facial nerve (n = 6), topical anesthesia (n = 5), and general anesthesia (n = 5). In 2 cases, the exact type of anesthesia was unknown but not general. The 5 topical with sedation anesthesia-related claims were due to inadequate pain control (n = 2), ocular movement resulting in capsular rupture (n = 2), or death (n = 1) allegedly related to excessive or inadequate monitoring of sedation. There were 5 claims related to general anesthesia including 4 deaths and 1 tooth loss during intubation. Sedation was alleged to be a factor in 5 cases resulting in death. Anticoagulants were a factor in 3 retrobulbar hemorrhage cases.


      Although claims and suits were infrequent given the large number of insured ophthalmologists and the large number of surgical cases requiring various types of anesthesia performed over the 10.5-year study period, severe injuries can occur.

      Abbreviations and Acronyms:

      ASCVD ( atherosclerotic cardiovascular disease), CPR ( cardiopulmonary resuscitation), DM ( diabetes mellitus), OMIC ( Ophthalmic Mutual Insurance Company)
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        • Nanji K.C.
        • Roberto S.A.
        • Morley M.G.
        • Bayes J.
        Preventing adverse events in cataract surgery: recommendations from a Massachusetts expert panel.
        Anesth Analg. 2018; 126: 1537-1547
        • Roberto S.A.
        • Bayes J.
        • Karner P.E.
        • et al.
        Patient harm in cataract surgery: a series of adverse events in Massachusetts.
        Anesthes Analg. 2018; 126: 1548-1550
        • Nanji K.
        • Morley M.
        Betsy Lehman Center for Patient Safety, Improving Patient Safety in Cataract Surgery.
        (September 2016.)
      1. Pennsylvania Patient safety Advisory, Pennsylvania Patient Safety Reporting System (PA-PSRS) Patient Safety Advisory—Vol. 4, No. 1.
        • Ophthalmic Mutual Insurance Company 2018 Members Report
        Ophthalmic Mutual Insurance Company.
      2. American Society of Anesthesiologists Physical Status Classification.
        • Anesthesia Quality Institute
        American Society of Anesthesiologists. About Closed Claims.
        Date accessed: July 21, 2019
        • Posner K.
        • Lee L.
        Anesthesia malpractice claims associated with eye surgery and eye Injury- highlights from the anesthesia closed claims project data request service.
        (American Society of Anesthesiologists. November 2014;78:28-30. Accessed February 19, 2019)
        • Lee R.M.H.
        • Thompson J.R.
        • Eke T.
        Severe adverse events associated with local anaesthesia in cataract surgery: 1-year national survey of practice and complications in the UK.
        Br J Ophthalmol. 2016; 100: 772-776
      3. Centers for Medicare and Medicaid Services Omnibus Burden Reduction Conditions Participation Final Rule.
        (Accessed 10/11/2019)
        • Keay L.
        • Lindsley K.
        • Katz J.
        • Schein O.
        Routine preoperative medical testing for cataract surgery.
        Cochrane Database Syst Rev. 2019; 1
        • Chen C.L.
        • Lin G.A.
        • Bardach N.S.
        • et al.
        Preoperative medical testing in Medicare patients undergoing cataract surgery.
        N Engl J Med. 2015; 372: 1530-1538
        • Menke A.
        • Salz J.
        Ocular anesthesia-related claims: causes and outcomes.
        OMIC Digest. 2006; 16: 1-5
        • Menke A.
        Ophthalmic Mutual Insurance Company, OMIC consents- anticoagulants.
        (Accessed 10/11/2019)
        • Menke A.
        Ophthalmic Mutual Insurance Company, Consent forms for cataract surgery anesthesia.
        (Accessed 10/11/2019)