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Objectives This study aimed to investigate the knowledge, attitude and practice (KAP) of primary care ophthalmologists regarding fundus examination during the perioperative period of cataract surgery in patients with diabetes mellitus.Design A cross-sectional study was conducted.Setting The study took place in hospitals in Shandong Province capable of performing cataract surgeries between June 2023 and January 2024.Participants A total of 245 primary care ophthalmologists participated, with 121 (49.39%) under 44 years old and 114 (46.53%) men.Interventions KAP scores and demographic characteristics were collected using a self-designed questionnaire. Mediation analysis was employed to explore relationships within KAP, including the potential impact of physician burnout on knowledge and practice.Primary and secondary outcome measures The average scores for KAP were 12.08±2.02 (possible range: 0–15), 47.77±3.41 (possible range: 11–55) and 28.34±2.35 (possible range: 6–30), respectively. Pearson correlation analysis assessed relationships between variables, revealing positive correlations between knowledge and practice (r=0.368, p<0.001) and attitude and practice (r=0.476, p<0.001).Results Negative correlations were noted between burnout and both knowledge (r=−0.275, p<0.001) and practice (r=−0.183, p=0.004). Mediation analysis showed that knowledge had a significant direct effect on practice (β=0.318, p=0.009), while its indirect effect through attitude was not statistically significant (β=0.058, p=0.224). Attitude had a significant direct effect on practice (β=0.440, p=0.010). Additionally, the number of cataract surgeries was positively associated with both knowledge (β=0.234, p=0.012) and practice (β=0.088, p=0.007), while age was negatively associated with attitude (β=−0.163, p=0.016) and practice (β=−0.072, p=0.007).Conclusions Primary care ophthalmologists showed satisfactory KAP towards fundus examination in diabetic cataract surgery. Further dissemination of guidelines, provision of adequate resources for postoperative follow-up and support for reducing physician burnout are essential. A comprehensive approach to education and system-level support is recommended to optimise patient care.