From Surgical Salvage to Blindness Prevention: A Real-World Study of Intraocular Surgery in Monocular Patients

Background: Intraocular surgery on patients with an irreversibly blind fellow eye carries high risks, often causing treatment delays due to patient and surgeon hesitation. Existing data beyond cataracts are scarce. This study aims to evaluate the clinical profiles, prognosis, and economic value of diverse surgeries in this monocular population to guide clinical decision-making and optimize blindness prevention strategies. Methods: This retrospective study included 308 patients with a pre-existing blind fellow eye who underwent primary inpatient intraocular surgery under a standardized clinical protocol between June 2021 and June 2025. Baseline demographics, bilateral etiologies, visual outcomes, postoperative complications, and average cost-effectiveness ratios (ACERs) were analyzed. Postoperative outcomes were evaluated for patients with at least 6 months of follow-up. Results: The primary surgical indications were cataract (51.3%), proliferative diabetic retinopathy (PDR, 19.5%), glaucoma (15.9%), and rhegmatogenous retinal detachment (RRD, 7.5%). Notably, 49.4% of patients exhibited identical blinding etiologies bilaterally. Among patients completing the 6-month follow-up (n = 109), overall mean BCVA significantly improved from 1.36 ± 0.77 to 0.73 ± 0.65 logMAR (p < 0.001). The cataract group achieved the greatest visual improvement and the lowest ACER. Despite surgical complexity and higher complication rates, PDR and RRD interventions achieved visual improvement in over 60% of cases. Conclusions: Despite high clinical stakes, timely surgery in monocular patients yields substantial visual and economic benefits. The notable disease symmetry highlights a critical window for early intervention, emphasizing the need for public health strategies that prioritize screening progressive bilateral diseases.