The Timeline Matters
The central issue is not simply that a poor outcome followed a procedure.
The question is what physicians knew at each decision point, what they could adequately visualize, what diagnostic investigation followed, and whether a potentially important window for diagnosis or intervention existed.
Before MPC
Cassie suffered from severe glaucoma and unusually complex ocular anatomy. Her left-eye pressure remained elevated despite extensive previous treatment.
Nevertheless, immediately before the relevant postoperative deterioration, she retained approximately 20/100 vision in that eye.
February 2024 — MPC
Micropulse cyclophotocoagulation was performed in an effort to control intraocular pressure.
For purposes of this review, the analysis specifically tested the case under the assumption that the decision to perform MPC and the procedure itself were medically appropriate.
The question then became:
Does a potential standard-of-care issue remain even under that assumption?
February 16 — Limited Posterior Visualization
The available record describes essentially:
“No view / small aperture.”
This becomes important because adequate visualization of the posterior segment was not available during a period surrounding the subsequent profound deterioration in vision.
February 23 — First Major Diagnostic Decision Point
By this examination:
Visual acuity: Hand motion
IOP: approximately 5 mmHg
Posterior visualization: inadequate/limited
PCO: dense
Plan: YAG and dilated fundus examination
An IOP of approximately 5 is an important postoperative data point, but this review does not claim that one low-pressure measurement establishes persistent hypotony or proves hypotony caused Cassie’s permanent vision loss.
The significance lies in the combination:
Abrupt profound visual deterioration + very low IOP + inadequate posterior visualization.
That combination raises the expert question of what investigation was indicated at that point.
March 28 — Second Major Decision Point
By March 28, IOP had recovered to approximately 15 mmHg.
The profound visual loss had not.
A YAG capsulotomy was performed to address the dense PCO.
The available record describes a limited posterior examination, including a poor view of the disc and a macula described as flat.
The materials presently assembled have not established an OCT, B-scan or equivalent posterior study that identified the anatomical explanation for the profound visual loss at this stage.
This creates a second important question:
If PCO was believed to explain the profound visual impairment, what diagnostic explanation replaced that hypothesis when treatment of the PCO failed to restore meaningful vision?
March to September 2024
A roughly six-month follow-up interval may be routine following an uncomplicated YAG procedure.
Cassie’s circumstances, however, require a different expert question:
Was that interval appropriate in a patient whose profound HM vision apparently remained unexplained after pressure recovery and treatment of the PCO?
The answer requires ophthalmic expert review.
September 27, 2024
Cassie was evaluated in person by Dr. Vasquez.
The materials presently assembled do not contain sufficient detail to reconstruct the complete left-eye examination from that encounter.
The complete record should establish:
- Left-eye visual acuity
- IOP
- Dilated fundus findings
- OCT or other imaging results
- Assessment and differential diagnosis
- Medication reconciliation
- Pred Forte instructions
- Treatment and follow-up plan
This encounter remains an important missing piece of the chronology.