an epithelial downgrowth. Rubbing can also dislocate the implant, he said,
causing the lens to rotate. Dr. Bowman, in accord with Dr. Jaffe's testimony,
also opined that if a lens is inserted and oriented horizontally at the 3:00 and
9:00 o'clock position, more likely than not, rubbing would not cause the haptics
to get caught in the iridectomy and dislocate.
In Dr. Bowman's opinion, the epithelial downgrowth could have developed in as
little as five days. It can grow up to one millimeter per day, and Alston's was
five millimeters in length. In his opinion, "something changed"
between the time of her last visit in October 1997 to Dr. Marvelli, when her
ocular pressure was normal, and November 1997, when he saw her.
Defendant's expert witness, Dr. James Key, has been a practicing
ophthalmologist for 24 years, and isChief of Ophthalmological Services at St.
Luke's Hospital in Houston, is a full professor at Baylor College of Medicine in
Houston, has authored a textbook on ophthalmology, and has published numerous
articles in peer review journals, none, however, on cataract and lens
implantation surgeries. Dr. Key testified that he always uses the superior
approach, as performed by Dr. Marvelli, on surgeries similar to Alston's with a
patient who has a sector iridectomy. The superior approach is still the one that
is used the most and is the one he teaches in the residency program at Baylor.
In his opinion, Dr. Marvelli's use of the superior approach was reasonable and
within the standard of care.
Dr. Key testified that most of the secondary implants with sector
iridectomies he has seen, while rare today, are positioned at an oblique angle,
generally at