A PATIENT'S JOURNEY FROM A CANNULA-ASSOCIATED OCULAR INJURY TO 6/6 VISION

To highlight the importance of practising safe surgery and following all the checks during surgery, including priming and checking the cannulas at every step of the surgery together with using a bimanual technic. 

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A 70-year-old female patient underwent a routine cataract extraction and lens insertion. At the conclusion of her surgery and during stromal hydration of the main wound, the cannula dislodged from the syringe while injecting BSS into the anterior chamber. The shooting of the cannula was significant enough to result in posterior capsule rupture and vitreous prolapse. The patient underwent an anterior vitrectomy with the use of triamcinolone.

At the day 1 postop visit, her visual acuity was Hand movement. She had significant corneal oedema with normal intraocular pressure and no fundal view. She continued her postop regimen medication (Acetazolamide 250 mg PO for 5 days, topical preservative-free antibiotics and preservative-free steroids)

At 1 week visit her visual acuity continued to improve (6/36) and she was comfortable but quite worried, nonetheless.

At her one-month visit, her visual acuity was 6/6. The patient was pleased with her vision and wanted her second eye surgery to be done by the same surgical team.

We describe the journey of a patient who had an unusual complication during a routine cataract surgery. We emphasized the importance of performing the necessary preop checks. The surgeon should follow the patient closely to achieve a good outcome for the patient both emotionally and functionally.

The patient rare surgical complication was well managed and despite a longer recovery time her visual acuity restored to 6/6 at 1 month follow-up visit. 

Cannula-associated ocular injury (COI) is a rare complication during cataract surgery. Several reports in the literature describe this, including a study over a 10 years period, however this is stressful for both the patient and the surgeon.

Both the cannula and syringe should be checked to ensure that they are securely connected. The surgeon should personally check and prime the syringe before introduction to the section and preferably angulate the cannula away from the posterior segment. A bimanual approach can also be employed to provide additional security.