What factors guide the choice between early versus delayed vitrectomy after an open globe injury?

The vitrectomy should be performed as early as possible in the presence of endophthalmitis or a posterior segment IOFB. The timing of retinal detachment repair (RDR) after open globe injury is controversial. The biggest risk of delaying RDR is the progressive development of proliferative vitreoretinopathy (PVR). Early vitrectomy (before 5 days) can be technically challenging due to increased intraoperative bleeding, significant corneal edema, and opening of an unstable OGI repair wound, which may limit a clear enough view to perform the posterior segment surgery. The best time to perform an RDR may be between 7-10 days when the corneal edema has somewhat decreased, the tissue is less inflamed, the OGI wound has somewhat healed, and the vitr...

Early vitrectomy should also be considered in Z2 and Z3 injuries before the onset of a PVD with subsequent RD or retinal breaks. Patients with ruptured lenses from penetrating ocular injuries should also undergo early PPV, especially if the integrity of the posterior capsule cannot be confirmed, as these patients are at a higher risk of post-OGI endophthalmitis.