4. Mr O complains the surgeon poorly did pars plana vitrectomy (PPV is a type of eye surgery) on 27 Sep 2019. Mr O also complains they did laser treatment at the same time, which he had not agreed to.
5. Mr O says his vision got worse after surgery and this was distressing and affected his ability to find work.
6. Mr O wants the Trust to accept the surgical outcome was poor and to make and service improvements. He also wants a payment of £5,000.
7. Mr O had a macular hole, which is a small gap that opens at the centre of the retina. He also had epiretinal membrane, a thin membrane or layer of scar tissue that forms over the retina. Surgery was done on 27 September 2019 to address this.
8. The surgeon confirmed that the macular hole was successfully repaired and as of June 2020, the problem had not come back. Mr O developed a cataract and the surgeon had warned him this might happen.
9. Since this surgery, Mr O tells us his vision reduced greatly. His central and fine detail vision has also deteriorated and he feels the surgery in September 2019 was supposed to improve this.
10. Mr O tells us that before this surgery his central and fine vision problem was only noticeable in a small area. But, the area is now much bigger in his right eye.
11. The surgeon said the vision problem was a result of a cataract causing a myopic shift (short-sightedness) and recommended surgery at his local hospital. He also said Mr O might then present with anisometropia, a condition that affects the sight in one eye due to refractive imbalances that may require correction.
12. Mr O had cataract treatment on 17 November 2020 and he says that since this the distorted central vision is much bigger and it has significantly affected his life. He also had YAG capsulotomy in October 2021, which is laser treatment that some people need after cataract treatment.
13. Mr O told us he knew he would need this treatment and he does not think his sight deterioration can be linked to the cataract or the cataract surgery. His concerns are with the surgery in September 2019.
17. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any signs that something has gone wrong.
Outcome of surgery
18. Mr O’s surgeon proposed PPV surgery after their assessment of the relevant scans. Mr O’s surgeon diagnosed him as having a macular hole.
19. The records confirm the surgeon did the PPV surgery with the intention of closing the macular hole. Our clinical adviser also told us this is routinely the aim of this surgery.
20. Our adviser confirmed the surgery on 27 September 2019 was successful. This is because scans done afterwards show the macular hole was closed. This is why the Trust also saw the treatment as successful.
21. There is no evidence to suggest anything went wrong with this surgery.
22. The records also refer to outer retinal defects. Our adviser said this phrase suggests there was some weakness of the retina already. The post-operative report also refers to residual irregularities of the inner retina.
23. NHS website information says that vision will never completely return to normal and that central vision can continue to deteriorate after macular hole surgery.
24. Before his treatment, the records show that Mr O’s visual acuity was 6/12. This means that he could see at six meters what most people can see at twelve.
25. The study referred to in the evidence section found there was a 96% closure rate as a result of surgery. But, only 46% had a visual acuity of 6/12 or better. This further suggests that unfortunately, Mr O’s eyesight was unlikely to improve or even stabilise. Sadly, the prognosis for Mr O was perhaps not as good as he hoped.
26. Our adviser told us that although there is always the hope for improvement to eyesight after PPV surgery, surgeons would usually explain that the vision is unlikely to return to normal.
27. Mr O also had cataract treatment after his PPV procedure which while common, caused a further delay to him knowing what his long-term visual acuity would be. We appreciate this is likely to have caused more uncertainty.
28. Mr O told us that his surgeon gave him verbal assurances that his sight would improve after surgery. We can also see from the consent form signed before the procedure that another intended benefit of the surgery was to ‘improve/stabilise vision’.
29. It is difficult to know if, or how, Mr O’s surgeon managed his expectations and we cannot comment on what was discussed in person. It is clear that he was hoping for improvements to his sight.
30. This suggests that his expectations could have been managed better and the fact his eyesight has not improved has left him concerned the surgery was not a success.
31. We are in no way disputing that Mr O’s eyesight has got worse and we do understand why this will be disappointing for him.
32. But we have not seen evidence that anything went wrong or that his worsening eyesight is in any way linked to the surgery itself.
33. We hope this reassures him that there is nothing to suggest there were clinical failings.
Laser treatment
34. The Trust did not offer a detailed response to his concerns about his surgeon doing laser treatment as well.
35. The records refer to ‘Endolaser to complete anterior retinopexy’ and our adviser confirmed that Mr O’s surgeon did laser treatment with the PPV surgery.
36. NHS website information says there is a 6% risk of retinal detachment after macular hole surgery. Our adviser said this is because the instruments used for the surgery are placed into the eye and may create or cause issues to pre-existing retinal tears. Considering this, our adviser confirmed that the laser treatment was clinically appropriate.
37. Our adviser told us it was crucial that Mr O’s surgeon checked the peripheral retina and treated any tears when carrying out this surgery. Mr O also has a myopic eye and tears are more likely to exist in this type of eye. Although Mr O had laser treatment before to repair a retinal tear, to be fully effective and safe the laser needs to surround the tear.
38. Mr O’s surgeon found the previous laser had not gone round the anterior (front) side of the tear and this is why they did more laser treatment.
39. Mr O is worried the laser treatment affected his vision. Our adviser said they do not believe the laser treatment had any effect on the central retina or the surgical outcome. Laser treatment is considered standard treatment if a tear is found.
40. Having reviewed all the information, we have seen no sign that anything went wrong. The laser treatment was necessary and appropriate and there is no evidence to suggest this affected his vision.
41. Our decision is not meant to take away from Mr O’s experience. We recognise he has been greatly affected by his eyesight and we know he has had to make big changes to his lifestyle.
42. We hope this statement explains our decision and we wish him well for the future.
1. We have carefully considered Mr O’s complaint about Liverpool University Hospitals NHS Foundation Trust (the Trust). The deterioration of Mr O’s eyesight has understandably caused him a great deal of concern and we are sorry to hear about the difficulties he has experienced.
2. Mr O is unhappy that his eyesight got worse after retinal surgery. He has also raised concerns that laser treatment was done with the surgery.
3. We have seen no sign that anything went wrong and because of this, we have decided not to investigate further.