Visual outcomes after one-stage versus two-stage surgery for intraocular foreign body removal and open globe repair.

The choice between one-stage (removal during primary repair) and two-stage (delayed removal) surgical repair for intraocular foreign body injury is often based on injury characteristics, institutional capabilities, and surgeon expertise. This study aims to compare vision outcomes and complication incidence after one-stage (n = 70) and two-stage (n = 40) intraocular foreign body removal and surgical repair across multiple academic centers. We retrospectively reviewed 110 patients treated between 2000 and 2021 at four academic centers in the southeastern United States and stratified patients by initial vision into better than counting fingers or counting fingers and worse. Two-way repeated measures ANOVA found visual acuity improved (p < 0.001) after both one-stage (ΔVA = -0.69) and two-stage (ΔVA = -0.23) repairs, but one-stage repair was associated with greater vision improvement (p = 0.009) and there was no interaction with initial vision (p = 0.337). Endophthalmitis rates were not significantly different for each treatment group (12.9% vs. 10.0%, p = 0.655). The number of additional surgeries did not differ significantly between treatment groups (p = 0.153). One-stage repair is associated with better vision outcomes if feasible, but two-stage repair is sometimes necessary and not associated with more endophthalmitis.