Clinical Predictors and Recovery Patterns of Visual Impairment as a Post-Stroke Complication: A Retrospective...

Background/Objectives: Visual impairment is an underrecognized but functionally disabling complication of stroke that adversely affects rehabilitation potential, autonomy, and quality of life. Clinical, anatomical, and ophthalmologic determinants of post-stroke visual recovery remain incompletely defined, particularly in Eastern European tertiary stroke units where structured visual follow-up is not standardized. This study aimed to identify clinical, imaging, and ophthalmologic predictors of favorable visual recovery and to evaluate whether integrating these domains improves early prognostic stratification beyond standard neurological assessment. Methods: We conducted a retrospective single-center cohort study of 71 consecutive adult patients admitted with acute stroke and a documented visual complication between January 2022 and September 2025 at Pius Brinzeu Emergency County Hospital and Victor Babes University of Medicine and Pharmacy Timisoara. Favorable recovery was defined as ≥50% improvement in visual field index (VFI) at 6 months. Group comparisons used Student's t-test, Mann-Whitney U test, chi-square test, and Fisher's exact test. Multivariable logistic regression, Cox proportional hazards modeling, and unsupervised k-means clustering were performed. Results: Twenty-nine patients (40.8%) achieved favorable recovery, while 42 (59.2%) had persistent impairment. Responders were younger (62.8 ± 10.7 vs. 70.4 ± 10.8 years, p = 0.005) and had lower admission National Institutes of Health Stroke Scale (NIHSS) (6.4 ± 2.9 vs. 10.3 ± 4.4, p < 0.001), smaller lesion volumes (18.7 ± 11.4 vs. 33.2 ± 18.7 mL, p < 0.001), thicker peripapillary retinal nerve fiber layer (89.3 ± 7.6 vs. 78.2 ± 9.4 μm, p < 0.001), and earlier rehabilitation initiation (11.4 ± 5.3 vs. 21.7 ± 9.8 days, p < 0.001). NIHSS, time to rehabilitation, and optical coherence tomography (OCT) pRNFL thickness remained independent predictors. The full integrated model achieved an area under the receiver operating characteristic curve (AUC) of 0.87. Cluster analysis identified three distinct phenotypes with favorable recovery rates of 79.2%, 34.8%, and 8.3%. Conclusions: Combined clinical, neuroimaging, and ophthalmologic profiling-particularly OCT pRNFL-meaningfully refines early prediction of post-stroke visual recovery and supports phenotype-driven rehabilitation planning.