Sir,

The evolution of cataract surgery continues. Surgery has progressed rapidly from ICCE to sub-3-mm sutureless phacoemulsification. In 1996, 66% of anaesthetic was peribulbar, but modern surgery requires only subtenon (47%) or topical ±intracameral (27%) administration.1 All these advances are backed by evidence. However, there is a relative paucity of data supporting postoperative ocular protection. Some surgeons routinely employ an eye shield for up to 6 weeks, whereas others completely avoid any ocular protection. Current practice is varied predominantly based on historical and anecdotal evidence. Shield users cite valid arguments. They confer confidence to both patient and surgeon by providing a physical barrier to recently operated eyes and protect from errant fingers. However, the routine use of shields was questioned 20 years ago,2 yet there remains no definitive answer to whether they are still necessary for modern micro-incisional surgery?

A study of 133 patients following topical cataract surgery found that ocular protection confers no safety benefit but elicits higher rates of patient discomfort with 53% of patients feeling it was unnecessary.3

We retrospectively analysed electronically all cataract procedures between 1 April 2010 and 31 March 2011 (n=1407). One surgeon used no shields throughout this period (regardless of patient factors; n=425). All other cases (n=982) wore a Cartella shield overnight for three weeks. Both groups contained similar demographics and wound construction (Table 1). The shield-less regime conferred no safety disadvantage. All adverse events had nonsignificant P-values with Fisher's exact test (Table 1).

Table 1 Comparing shield and shield-less cohorts
Full size table

A total of 46 patients responded by anonymous questionnaire; 59% stating shields were ‘uncomfortable’ and 43% would have ‘preferred to not wear’ one. Comments included ‘If it helps I will wear it’ and ‘I assume I was given it for a reason’. With the recent advances in wound construction, surgical outcomes and complication rates is the routine use of shields without evidence still necessary in 2011?