ObjectiveTo compare and observe the visual acuity and ocular anatomical outcome of different subtypes in open-globe injury (OGI) Ⅲ. MethodsA retrospective study. A total of 187 eyes of 187 patients with OGI involving zone Ⅲ who were admitted to the Department of Ophthalmology of The First Affiliated Hospital of Army Medical University from January 2020 to December 2023 were included in the study. According to the 2022 International Globe and Adnexal Trauma Epidemiology Study groups consensus, zone Ⅲ was further divided into Ⅲa zone (5-8 mm posterior to the limbus) and Ⅲb zone (＞8 mm posterior to the limbus), with 58 eyes (31%, 58/187) in group Ⅲa and 129 eyes (69%, 129/187) in group Ⅲb. Best corrected visual acuity (BCVA) was examined using the international standard decimal visual acuity chart, converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity when recorded. The injured zone, initial visual acuity, final visual acuity, retinal detachment (RD), uveal prolapse, and proliferative vitreoretinopathy (PVR) were collected. The follow-up time after surgery ≥ 6 months. The final visual acuity and anatomical prognosis of the two groups were observed. Silicone oil dependence, phthisis, and enucleation were defined as poor anatomical outcomes. Multiple linear regression analysis was performed to analyze the impact of zone Ⅲb of OGI on the final visual acuity. ResultsAt the 6-month follow-up, the logMAR BCVA of group Ⅲa and group Ⅲb was 1.49±1.0 and 2.51±0.85; there was a statistically significant difference in the logMAR BCVA between the two groups (t=−2.736, P＜0.05). Compared with group Ⅲa, the proportion with light perception in group Ⅲb was higher, and the proportions with visual acuity of hand movement, counting fingers, and ＞0.01 were lower, and the differences were all statistically significant (P＜0.05). Compared with group Ⅲa, RD and PVR were more likely to occur in group Ⅲb, and the differences were all statistically significant (χ2= 16.696, 8.697; P＜0.05). Among the affected eyes in group Ⅲa and group Ⅲb, there were 14 eyes (24.1%, 14/58) and 95 eyes (73.6%, 95/129) with poor final anatomical outcomes respectively; the incidence of poor final anatomical outcomes in group Ⅲb was higher, and the difference was statistically significant (χ2= 40.332, P＜0.01). The results of multiple linear regression analysis showed that initial visual acuity, RD, and uveal prolapse were independent risk factors affecting the final visual acuity (odds ratio=2.407, 4.162, 3.413; P＜0.05). ConclusionsPatients with OGI in zone Ⅲb have a worse visual prognosis and a higher incidence of poor anatomical outcomes. The subclassification of zone Ⅲ is helpful for better predicting the prognosis of OGI clinically.