Short-term visual acuity outcomes and prognostic factors following 25-gauge pars plana vitrectomy for intraocular foreign body extraction

Objective To characterize the clinical presentation of intraocular foreign body (IOFB) injury and evaluate the short-term visual acuity outcomes following 25-gauge pars plana vitrectomy (PPV), with identification of independent predictors of postoperative visual recovery. Methods A retrospective study was conducted on 198 patients (198 eyes) diagnosed with IOFB who underwent 25G minimally invasive PPV at the Department of Ophthalmology, First Hospital of Hebei Medical University, between January 1, 2020, and December 31, 2024. Clinical characteristics of the IOFB, therapeutic efficacy of PPV, and best corrected visual acuity (BCVA) were analyzed to identify factors influencing postoperative visual acuity. Furthermore, receiver operating characteristic (ROC) curve analysis was performed to validate the predictive accuracy of the model for postoperative visual outcomes. Results Among the 198 patients, most were young and middle-aged males residing in rural areas. Metal IOFB were the predominant type, accounting for 141 eyes (71.2%). The majority of these foreign bodies entered through Zone I (157 eyes, 79.3%), with a complete intraoperative removal rate (100%). Preoperatively, BCVA was ≥0.1 in 81 eyes and <0.1 in 117 eyes. Postoperatively, BCVA improved to ≥0.1 in 126 eyes, while it remained below 0.1 in 72 eyes. This improvement in BCVA after surgery was statistically significant ( p < 0.001). Multivariate logistic regression analysis revealed that poor preoperative BCVA, macular involvement by the foreign body and coexisting endophthalmitis were independent risk factors for suboptimal postoperative visual outcomes. A composite predictive model integrating these three variables exhibited strong discriminatory performance, with an area under the AUC of 0.797 (95% confidence interval: 0.735–0.859), with a sensitivity of 94.4% and specificity of 55.6%, indicating high predictive accuracy. Conclusion 25G minimally invasive PPV effectively improves visual acuity in the majority of patients with IOFB. Preoperative poor BCVA, macular impaction of foreign bodies and coexisting endophthalmitis are significant independent risk factors for short-term suboptimal postoperative visual outcomes.