Inadvertent cannula detachment during cataract surgery: A national survey of Canadian cataract surgeons

To determine the lifetime exposure and perceived causes of inadvertent cannula detachment during cataract surgery in Canada, and to describe practice modifications adopted following these events. Twenty-question online survey. A total of 136 Canadian cataract surgeons. A 20-item online survey (Qualtrics) was distributed to 818 Canadian cataract surgeons via the Canadian Ophthalmological Society. The survey was available in English and French, with implied consent through participation. Quantitative responses were summarized using descriptive statistics, and qualitative responses were categorized into thematic groups and reviewed by two investigators. Ethics approval was obtained from the University of Alberta Research Ethics Board (Pro00154552). Of the 818 Canadian cataract surgeons, 136 (16.6%) responded, with a median of 12,000 surgeries performed per surgeon. Among respondents, 69 of 136 (50.7%) reported having experienced or witnessed at least one detachment event in their lifetime, accounting for a cumulative total of 157 events. Detachments most frequently occurred during wound hydration (31.9%), anterior chamber filling (20.3%), and hydrodissection or delineation (15.9%). Most incidents involved a 27-gauge cannula (60.9%), a 3-mL syringe (63.8%), and a Luer-lock connection (50.7%). Among affected surgeons, 41 of 69 surgeons (59.4%) reported complications, and 14 of 69 (20.3%) reported that at least one patient required additional surgical interventions. Failure to securely tighten the cannula was identified as the most commonly perceived contributing factor (76.8%). Following inadvertent cannula attachment, 85.5% of surgeons (59/69) reported implementing changes in practice including personal tightening of the cannula, exclusive Luer-lock use, test injections, and cannula stabilization during injection. Inadequate tightening was the most commonly perceived cause of inadvertent cannula detachment. However, given the 16.6% response rate, these findings should be interpreted cautiously, as they may not be representative of all Canadian cataract surgeons and may overestimate lifetime exposure due to response bias. Although these findings highlight surgeon-perceived contributors to cannula detachment, particularly inadequate tightening, prospective study is needed before these perceptions can inform evidence-based preventive measures.