To Shield Or Not To Shield: A Review Of Routine Cataract Cases With And Without Post-Operative Cartella Shields In A Tertiary Uk Eye Centre

To evaluate the impact of omitting a post-operative protective eye shield following routine phacoemulsification cataract surgery compared with standard shield use.

A prospective comparative audit was conducted of consecutive patients undergoing routine cataract surgery at a tertiary UK eye centre. Patients who had cataracts surgery between 17/02/25 - 26/02/25 were analysed 

Two cohorts of patients who had cataracts surgery between 17/02/25 - 26/02/25 were analysed : patients discharged with a post-operative eye shield (shield group) and those discharged without a shield (shieldless group). The primary outcome measure was unplanned reattendance to eye services. Data collected included laterality, surgeon grade, time to reattendance, post-operative complications, and need for additional treatment. Secondary outcomes assessed patient experience using post-operative Google Forms surveys administered via tele-consultation by two investigators (MTM, ZM).

164 eyes were analysed: 52 shielded and 112 shieldless. In the shield group, 17% reattended (33% unplanned); one CMO, one post-op uveitis needing ongoing treatment, and one normal exam requiring no treatment. In the shieldless group, 16% reattended (11% unplanned): one rebound uveitis and one CMO, both treated with drops. No endophthalmitis, trauma, lens issues or iris prolapse occurred. Of shieldless patients, 64% responded; 85.9% rated care excellent (97.2% excellent/good), 84.5% were comfortable overnight, though most would have worn and believed in a shield.

Omission of a post-operative shield was associated with a reduction in unplanned early reattendance. Although, whilst the shieldless cohort demonstrated a lower rate of unplanned reattendance (1.8% vs 5.8%), this difference did not reach statistical significance. While most presentations were non-sight-threatening and patient-reported comfort without a shield was high, the majority of patients still perceived shields as necessary. We have demonstrated a non-inferiority of shieldless cataract surgery in appropriate routine cases, although patients reported a shield as necessary, and therefore further data and qualitative discussion with patients would be required to adopt this approach for routine cases.