Factors related to poor visual outcomes in open globe injuries.

Abstract

Objective: To identify clinical and injury-related factors associated with poor visual outcomes in patients presenting with open globe injuries, Study Design: Analytical Cross-sectional study. Setting: Department of Ophthalmology, Nishtar Hospital, Multan. Period: February 2025 to December 2025. Methods: This analytical cross-sectional study was conducted in the Department of Ophthalmology at Nishtar Hospital, Multan. Patients with clinically diagnosed open globe injuries who underwent primary surgical repair and completed a minimum follow-up of six months were included. Demographic data, mechanism and zone of injury, presenting visual acuity, associated ocular findings and management details were recorded. Visual acuity was assessed at presentation and at final follow-up. Factors associated with poor visual outcomes were analyzed using appropriate statistical methods. P value of <0.05 was considered statistically significant. Results: A total of 120 patients with open globe injuries were analyzed, with a mean age of 32.6 ± 14.8 years and a male population (76.7%). Laceration injuries were slightly more common than rupture injuries (54.2% vs. 45.8%). More than half of the patients (56.7%) presented with visual acuity worse than 6/60. Zone III injuries were observed in 30.0% of cases. Common associated ocular findings included lens injury (48.3%), vitreous hemorrhage (43.3%), retinal detachment (28.3%), intraocular foreign body (18.3%) and endophthalmitis (11.7%). At final follow-up, poor visual outcomes were significantly associated with rupture-type injuries, Zone III involvement, poor presenting visual acuity, retinal detachment and endophthalmitis (p < 0.05). Conclusion: Poor visual outcomes following open globe injuries are primarily determined by the severity and anatomical extent of the injury at presentation. Poor presenting visual acuity, rupture mechanism, posterior segment involvement, retinal detachment and post-traumatic endophthalmitis are the most important predictors of unfavorable visual prognosis. Early surgical intervention and preventive strategies remain essential to reduce visual morbidity associated with open globe injuries.