Impact of traumatic lens injury on visual and anatomical prognosis following open globe injuries: an analysis from a tertiary trauma referral center.

BACKGROUND

This study aims to evaluate the impact of traumatic lens injury on visual and anatomical prognosis in open globe injuries (OGI).

METHODS

The medical charts of patients with OGIs treated at a tertiary ocular trauma referral center between November 2016 and January 2025 were retrospectively reviewed. Patients were categorized into two groups: those with lens injury (LI) and those without lens injury (NLI). Primary outcome measures were final best-corrected visual acuity (BCVA), functional visual success (BCVA ≥ 0.1 [decimal]), and globe survival. Multivariate logistic regression analyses were utilized to model independent predictors of functional visual success and globe survival. Predictor variables were selected based on clinical relevance and prior trauma literature: lens injury, Zone 3 involvement, injury type, number of surgeries, and initial retinal detachment.

RESULTS

A total of 98 eyes were included in the study; 73 eyes had LI, while 25 eyes did not. Eyes with LI had significantly poorer initial BCVA (mean logMAR 2.33 vs. 1.76; p=0.003) and more frequently sustained Zone 1 injuries (p<0.001). Final BCVA (logMAR 1.62 vs. 1.00; p=0.022), functional visual success (23.3% vs. 60.0%; p=0.002), and globe survival (63.0% vs. 88.0%; p=0.037) were all significantly lower in the LI group. In the multivariable analysis, lens injury independently reduced the likelihood of functional visual success (adjusted OR 0.40; 95% CI 0.11-0.81; p=0.019), whereas it was not an independent determinant of globe survival. The presence of initial retinal detachment was the strongest adverse factor for both functional visual success (adjusted OR 0.07; 95% CI 0.02-0.44; p<0.001) and globe survival (adjusted OR 0.13; 95% CI 0.04-0.40; p<0.001).

CONCLUSION

Traumatic lens injury independently predicts poorer functional visual success following OGIs. Retinal detachment at presentation remains the most influential determinant of both visual and anatomical prognosis and holds critical importance in trauma management. Incorporation of lens injury into ocular trauma prognostic scoring systems may improve their predictive accuracy.