BackgroundThe reporting of cataract surgical outcomes serves as quality control checks to optimize postoperative vision outcomes and/or minimize ensued complications. However, there is paucity of data from low-and-middle-income countries such as Ghana. This study determined postsurgical visual outcomes after cataract surgery and assessed factors associated with poor postoperative visual acuity in the Eastern region of Ghana. Methods The study gathered data by mixed methods approach; quantitative and qualitative. Systematic random sampling was used to select 384 medical folders of patients who underwent cataract surgery from January 1 to December 31, 2017 in selected hospitals with ophthalmologists in the eastern region of Ghana. A pretested questionnaire was used to collect postoperative vision outcome data. Similarly, a key informant interview guide was employed to gather relevant ophthalmic expert views on predictors of postoperative outcomes using the World Health Organization cutoffs. Quantitative data were summarized with descriptive statistics (means, frequencies, percentages) and a logistic regression model. Qualitative data was explored with thematic or content analysis. Cataract surgical outcomes were measured based on visual acuity six weeks after surgery.Results Good postoperative visual acuity (≥6/18), borderline (6/24-6/60), and poor visual outcomes (<6/60) were estimated at 71.6%, 26.8%, and 1.8%, respectively. The major systemic comorbidities were hypertension (21.4%) and diabetes (9.4%), whereas the determinants of poor visual outcomes were postsurgical complications, biometry, comorbid, and complications during surgery. Only postsurgical complication (OR = 1.72, p = 0.000) was significantly associated with poor postoperative visual acuity. Further, ophthalmic surgeons reported postsurgical complications (90.0%) as the significant risk factor to sub-standard visual outcomes in the region. Conclusions Although our results showed satisfactory postoperative visual acuity after cataract surgery, nearly one-third had borderline and poor visual outcomes. Hence, measures needed to improve borderline cases and further mitigate complications associated with poor postoperatively visual acuity are warranted.