Plaintiff had complained to his doctor about blurry vision and was diagnosed with Fuchs Endothelial Corneal Dystrophy (FECD), an eye disease where the corneal epithelium becomes edematous, due to malfunction of the pumping function of the endothelial cells. Additionally, Plaintiff was diagnosed with nuclear sclerosis in both his right and left eye.
The plaintiff was diagnosed with nuclear sclerosis, endothelial corneal dystrophy, epiretinal membranes, and dry eye syndrome in both eyes. If not treated, the cornea would completely decompensate, and it would require consideration of corneal transplant surgery. The plaintiff was then scheduled for a cataract surgery, which occurred a few weeks after this diagnosis. After a cataract surgery, he was referred to an eye bank for a possible DMEK surgery. DMEK surgery stands for Descemet’s Membrane Endothelial Keratoplasty. It is a highly specialized form of corneal transplant used to treat conditions where only the innermost layer of the cornea (the endothelium) is damaged. The eye bank made an arrangement to receive the “DMEK Prepared Culture” from a third party, which in turn made an arrangement with a fourth party to procure the “DMEK Prepared Cornea” for the aforementioned DMEK surgery.
None of the defendants had cultured the sample prior to the surgery, which would have shown that the donor rim contained a fungus. The presence of a fungus in a cornea that will be transplanted can lead to serious complications for the recipient of said cornea. The presence of fungal growth can lead to fungal infections in the corneal donor tissue. Potential complications from a fungal infection, include but aren’t limited to fungal keratitis and endophthalmitis. Fungal infections can be vision threatening. Grafts cultures of the corneal donor tissue prior to surgery could reduce the risk of the patient developing a fungal infection, which in turn would reduce the risk of the patient losing their vision.
After the DMEK operation of the right eye, the plaintiff complained during a post-operative visit of discomfort in his right eye. The plaintiff was noted with some subepithelial haze, 50% air bubble-clear pupil edge, and that the graft was well attached and small abrasion measuring 2 mm x 1 mm. At plaintiff’s next post-operative visit, plaintiff’s eye culture showed moderate Candida glabrata. A culture of the corneal donor rim, showed many Candida glabrata. As a result, plaintiff eventually underwent pars plana vitrectomy in the right eye and injection of Amphotericin to the right eye for endophthalmitis in the right eye under local anesthesia. Five months later, the plaintiff stated there were black spots in his vision in the right eye on the left side.
The plaintiff contended that the defendant was negligent in failing to measure corneal thickness and endothelial cell density prior to the operation to assess the risk of corneal decompensation following cataract surgery. Studies have shown significant endothelial cell loss in patients who have been diagnosed with FECD, which places them at a higher risk for
subsequent corneal decompensation. Given the plaintiff’s diagnosis with FECD, the defendant should have done meticulous preoperative, intraoperative and postoperative considerations to achieve the best visual outcomes.
Additionally, the defendant failed to suspect fungal keratitis in the setting of positive donor rim culture for Candida glabrata. The defendant should have begun to start the patient on antifungal treatment. The culture of the corneal donor rim returned positive for Candida glabrata five days after the collection of the culture. It is standard for patients with positive donor rim cultures to be monitored closely for signs and symptoms of infection. Yet, even though the plaintiff’s donor rim culture was positive for Candida glabrata, a fungus, the plaintiff was not treated with antifungal medications.
As a result of the medical malpractice, Plaintiff suffered serious and permanent loss of vision in the effected eye injuries. The case settled for a high six figure number, shortly after the defendant’s motion to dismiss the plaintiff’s case for failure to state a cause of action, was denied.
This was a case of national first impression, since nowhere in the country had an eye bank nor a medical provider been held accountable for such a duty, which the plaintiff contended was necessary to protect patients, like the plaintiff, from such foreseeable harms. Indeed, prior to retaining this office, the plaintiff’s had consulted several well know large plaintiff’s medical malpractice firms in the New York Metropolitan area, who all rejected the plaintiff’s claim, since these law firms were of the view that the claims were not supportable under existing law.
We had heartfelt compassion for the plaintiff’s claims, and we believe that either the cause of action was supportable under existing law, or it was time to create new law. Fortunately, the New York State Supreme Court agreed with our view.
