Eyeworld

50 | EYEWORLD | FALL 2026 ATARACT C Contact Alwitry: amaralwitry@btinternet.com Lindsey: jllindsey@meei.harvard.edu Reference 1. Alwitry A. Prevalence of can- nula dislocation during cataract surgery: a survey. J Cataract Refract Surg. 2025;51:1034–1036. Relevant disclosures Alwitry: Dr. Alwitry has worked with industry to develop the Cannusafe safety device to prevent harm from cannula detachment. Lindsey: None or ophthalmic viscosurgical devices, the cannula can come off with significant force and veloc- ity and result in harm to delicate intraocular tissues." The complication can occur at various points of the cataract surgery but may be more likely during stromal wound hydration. "This is likely because the tip of the cannula is partially or completely occluded during the hydration process, which increases the amount of pressure buildup within the syringe during the injection, leading to sudden ejection of the cannula into the eye," Dr. Alwitry's publication stated. This issue can lead to complications such as corne- al edema, iris injury, hyphema, capsular tear/ rupture, zonular dialysis, vitreous loss, vitreous hemorrhage, retinal detachment, or macular injury. Dr. Alwitry said surgeons and key opinion leaders need to engage viscoelastic suppliers and consumable pack providers to ask for safety devices that prevent this. He emphasized that while two viscoelastic providers have made partial responses, these address only one of the 5+ syringes used per case. with FLACS, and it is best to take some time to release the cavitation bubbles prior to hydrodis- section." Cannula dislocation during cataract surgery Amar Alwitry, MD, brought up a safety concern that he has published on, cannula dislocation during cataract surgery. 1 He noted that there were more than 500 respondents to a survey to bring awareness to this complication. In the survey, 84% of respondents had experienced cannula displacement during cataract surgery, and 78% had witnessed resulting patient harm because of the complication. Dr. Alwitry said the major issue is that the liquid being injected through the small lumen cannula creates big hydraulic force. If the can- nula is not attached properly, it can come off. The problem with this in an ophthalmic pro- cedure is the end of the cannula is not secured in the tissue but rather is loose in the aqueous of the eye. "There is nothing stopping it from firing forward and causing harm to the delicate eye structures," he said, adding that it could impact the cornea, lens, iris, zonules, or retina. "Eye surgery is at particular risk because we repeatedly lubricate the friction junction we rely on for safety with balanced salt solution and viscoelastic." He estimated that because of the large number of cataract surgeries per year, this can add up to be a big concern. He added that since there are 4–5 syringes/cannulae used per cata- ract procedure, these all pose a risk. Dr. Alwitry said it's hard to prepare for this potential complication, noting that there's no current precaution protocol and no central registry to keep track of it. Two viscoelastic pro- viders have examined this issue. One created a screw cap that goes over the end of the cannula and secures it to the syringe, and the other has a clip. However, this only protects patients in certain cases where these specific products are being used, he said. Experiencing this complication can cause visual loss and harm, Dr. Alwitry said. He called attention to Luer lock syringes in his published commentary but said that despite their use, cannulas can still dislodge. The publication not- ed that "this is usually due to failure to tighten the needle fully or misthreading. Owing to the hydraulic forces produced when injecting fluids continued from page 49 Kevin M. Miller, MD, EyeWorld Cataract Editorial Board member, reflected on how ophthalmology is refining, combining, and reimagining modern care: "Peripheral corneal relaxing incisions (PCRIs) have been around for decades, and many surgeons have learned to incorporate them at the time of cataract surgery. They were frequently made before the advent of toric IOLs but remain useful for the correc- tion of low amounts of corneal astigmatism, especially when a surgeon plans to implant a multifocal or extended depth of focus lens. The reason for the continued popular- ity of PCRIs is that low power toric presby- opia-correcting lenses are not yet available to surgeons in the U.S. On a positive note, the creation of PCRIs has reached a high lev- el of accuracy and reproducibility with the introduction and widespread availability of femtosecond lasers." REFRESH. REFINE. REWIND.

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