Cannula Detachment – An Avoidable Complication With Significant Harm And Health Economic Costs

Cataract surgery is an inherently safe procedure.  The use of Luer lock syringes is standard practice however, despite that ocular harm is still occurring due to the cannula detaching from the syringe into the eye, damaging ocular structures and resulting in visual loss or even blindness.  This has been reported extensively in the literature and has been the subject of two recent safety alerts by the Royal College of Ophthalmologists in England.  We assess the world literature and detail the issue, the causes, the health economic impact and the potential solutions.

Review article.

The world literature is assessed and current and future potential solutions are discussed.

A recent survey facilitated by the ESCRS found that this complication happens quite frequently.  Five hundred and fifty-five eye surgeons responded.   84% of respondents had experienced dislocation of the cannula during an intraocular procedure.  78% had seen episodes of harm; 50% said that the last time it occurred there was ocular damage.  38% said it occurred on average twice per year, 16% 3 times per year, and 7% stated that it occurred 4 or more times per year.  In excess of $200M per year worldwide is wasted on legal fees due to this avoidable complication.  There is also a cost in managing the complications with additional costs of $4,663 to treat per patient with an additional workdwide healthcare spend of $932M per year.   

This is a significant problem and an avoidable cause of visual loss.  There are significant health economic costs associated with this complication.  Current solutions are inadequate and there is a need for more recognition of this issue and the development of devices to abolish this complication.