The timing of reconstruction in severe mechanical trauma

Serious ocular trauma involving the posterior segment remains rather common and, despite many technological advances in recent years, continues to represent a significant management challenge to the ophthalmologist. One of these challenges is to identify the most optimal timing for the ultimate reconstruction, namely vitrectomy. While it is fairly obvious that suture-closure of the wound of open-globe injuries should be done as soon as possible, it is less clear whether vitrectomy should be performed in the same surgical session (primary comprehensive reconstruction) or be deferred (staged approach), and if so for how long. In this review, 4 options for staging are offered: early (days 2-4); delayed (days 5-7); late (days 8-14), and very late (past 2 weeks). The earlier the vitrectomy, the higher the risk of intraoperative complications. Conversely, the later the vitrectomy, the higher the incidence and severity of postoperative complications, of which proliferative vitreoretinopathy is the most damaging.