Outcomes and prognostic factors in posterior segment intraocular foreign body injuries

Posterior segment intraocular foreign body (IOFB) injuries are among the most severe forms of ocular trauma and are associated with highly variable visual outcomes. Identifying reliable prognostic factors remains clinically challenging.

This longitudinal study included 117 patients who underwent surgical removal of posterior segment IOFBs at a tertiary referral center between 2016 and 2021. Demographic data, injury characteristics, ocular findings, surgical variables, and Ocular Trauma Score (OTS) were recorded. Best-corrected visual acuity (BCVA, logMAR) was assessed preoperatively and up to 12 months postoperatively. Univariate and multivariable linear regression analyses were performed to identify predictors of final BCVA.

Mean BCVA improved significantly from 1.51 ± 0.84 logMAR preoperatively to 0.97 ± 0.77 logMAR at 12 months (P < 0.001). Poor visual outcome was significantly associated with the presence of RAPD, endophthalmitis, retinal detachment, traumatic cataract, and larger IOFB size. OTS demonstrated the strongest independent association with final BCVA (β = - 0.81, P < 0.001). Hammering-related injuries were associated with better visual outcomes.

Visual outcomes after posterior segment IOFB injuries are largely determined by initial trauma severity. The Ocular Trauma Score is a robust predictor of final visual acuity and should be incorporated into early risk stratification and patient counseling.