Traumatic Endophthalmitis After Ocular Injury: Microbiologic Spectrum and Predictors of Visual Outcome in a Multicenter Retrospective 22-Year Case Series

Background Traumatic endophthalmitis remains a vision-threatening emergency after open globe injuries. We aimed to describe epidemiology, microbiology, management patterns, and outcomes across tertiary centers, and to identify factors associated with poor final best-corrected visual acuity (BCVA). Methods Multicenter retrospective case series of consecutive eyes with traumatic endophthalmitis treated from January 2003 to January 2025 in seven tertiary hospitals. Demographics, injury details (including intraocular foreign body, IOFB), clinical findings, microbiology, and treatments (intravitreal antibiotics and pars plana vitrectomy, PPV) were analyzed. The primary outcome was final BCVA (logMAR). Results Seventy-four eyes were included (93.2% male; 95.9% penetrating injuries; 60.8% corneal; 45.9% with IOFB). Culture positivity was 58.1%, predominantly Staphylococcus epidermidis . Intravitreal antibiotics were given in 70.3% and PPV in 64.9%. Mean time from trauma to diagnosis was 1.2 ± 1.6 days; mean time from diagnosis to first intravitreal injection was 0.3 ± 1.2 days. Mean BCVA improved from 2.10 ± 0.72 to 1.06 ± 1.26 logMAR at last follow up. Final BCVA ≤ 1.0 logMAR was achieved in 43.2%, while 16.2% required evisceration. On univariate analysis, worse baseline BCVA was associated with poor final BCVA (≥ 1.0 logMAR), whereas IOFB, retinal detachment (RD), culture positivity, intravitreal therapy, and PPV were not significant predictors Conclusions Despite standardized early care, functional recovery was limited. Baseline BCVA was the strongest prognostic indicator, supporting early risk stratification and rapid source control with guideline-concordant empiric therapy adapted to the work environments and climatic conditions.