A new large-scale analysis from the IRIS Registry has offered one of the clearest pictures to date of how patients fare after surgery to remove intraocular foreign bodies (IOFBs) – a sight-threatening emergency that most ophthalmologists will encounter at some point in their careers. With 4,784 eyes included, this is the largest study of its kind seeking to provide practical guidance for counselling patients about recovery and long-term visual expectations.
The study authors – based at University College London, Moorfields Eye Hospital and Massachusetts Eye and Ear – found that IOFB injuries remain uncommon but clinically significant, with a mean annual incidence rate of 2.28 per 100,000 patient-years. Most affected individuals were middle-aged men (70%), with a median age of 55 years – a demographic shift compared to older reports where younger men predominated. This likely reflects evolving patterns of work, as well as home exposure to high-risk DIY tools.
The majority of injuries were unilateral and occurred slightly more often in the posterior segment (51.8%) than the anterior (46.6%). Complications at presentation were also common, including retinal detachment (12.5%), cataract (10.5%), and vitreous hemorrhage (7.9%). Endophthalmitis was present in nearly 4% of cases.
Across the cohort, patients generally arrived with markedly reduced vision – median 1.24 logMAR (roughly 20/400) – yet many experienced meaningful recovery.
The visual recovery curve revealed a markedly consistent pattern of recovery: no significant improvement during the first postoperative month; rapid gains by month two, with an average improvement of 0.38 logMAR; gradual improvement up to month 18, stabilizing around a 0.59 logMAR gain.
In practical terms, patients were observed to need several weeks before they noticed clearer vision, but many continued to improve for more than a year.
A second analysis examining patients with pre-injury VA reinforced that eyes with the best pre-IOFB vision recovered the most, while those with pre-existing poor vision (≥1.0 logMAR) showed more limited improvement.
Notably, patients identifying as Black or African American had worse average VA outcomes, independent of clinical severity and socioeconomic factors. Although this association was not observed in sensitivity models focused on the median, the study authors emphasize the need for further study into health equity and access to care.
The multi-institutional team’s analysis provides realistic, data-driven expectations for recovery after IOFB surgery, allowing ophthalmologists to offer clearer guidance to these patients: vision often stabilizes only after two months, with continued but slower improvement thereafter; patients with complications such as retinal detachment or endophthalmitis require especially careful counseling. As the largest real-world dataset on IOFB injuries to date, clinicians now have a stronger foundation for prognostication and patient support following these complex and often devastating injuries.
The study authors – based at University College London, Moorfields Eye Hospital and Massachusetts Eye and Ear – found that IOFB injuries remain uncommon but clinically significant, with a mean annual incidence rate of 2.28 per 100,000 patient-years. Most affected individuals were middle-aged men (70%), with a median age of 55 years – a demographic shift compared to older reports where younger men predominated. This likely reflects evolving patterns of work, as well as home exposure to high-risk DIY tools.
The majority of injuries were unilateral and occurred slightly more often in the posterior segment (51.8%) than the anterior (46.6%). Complications at presentation were also common, including retinal detachment (12.5%), cataract (10.5%), and vitreous hemorrhage (7.9%). Endophthalmitis was present in nearly 4% of cases.
Across the cohort, patients generally arrived with markedly reduced vision – median 1.24 logMAR (roughly 20/400) – yet many experienced meaningful recovery.
The visual recovery curve revealed a markedly consistent pattern of recovery: no significant improvement during the first postoperative month; rapid gains by month two, with an average improvement of 0.38 logMAR; gradual improvement up to month 18, stabilizing around a 0.59 logMAR gain.
In practical terms, patients were observed to need several weeks before they noticed clearer vision, but many continued to improve for more than a year.
A second analysis examining patients with pre-injury VA reinforced that eyes with the best pre-IOFB vision recovered the most, while those with pre-existing poor vision (≥1.0 logMAR) showed more limited improvement.
Notably, patients identifying as Black or African American had worse average VA outcomes, independent of clinical severity and socioeconomic factors. Although this association was not observed in sensitivity models focused on the median, the study authors emphasize the need for further study into health equity and access to care.
The multi-institutional team’s analysis provides realistic, data-driven expectations for recovery after IOFB surgery, allowing ophthalmologists to offer clearer guidance to these patients: vision often stabilizes only after two months, with continued but slower improvement thereafter; patients with complications such as retinal detachment or endophthalmitis require especially careful counseling. As the largest real-world dataset on IOFB injuries to date, clinicians now have a stronger foundation for prognostication and patient support following these complex and often devastating injuries.
