0.8% of retinal detachments ( rds ) in the general population are secondary to trauma . most of these traumatic rds are in young patients with work - related trauma [ 3 , 4 ] . there is a general consensus that vitrectomy is the appropriate surgery for most traumatic rds , but other interventions may include scleral buckle , laser , retinopexy , or a combination of these based on the individual patient . in addition to repairing the retinal detachment , the benefit of early intervention with vitrectomy is to remove the maximum amount of vitreous , thus eliminating the depot for inflammation to settle and epiretinal membranes to form . some authors postulate that early intervention decreases postoperative proliferative vitreoretinopathy ( pvr ) , a complication that can lead to redetachment and has been found to be more common in eyes that have suffered trauma than in nontraumatic rd . others contend for delayed intervention , allowing time for the eye to recover , a complete posterior vitreous detachment to develop , and the pvr process to settle , thus making the surgery less complicated . they also maintain that there is a decreased risk of severe hemorrhage when operating several days after the inciting trauma , particularly in eyes with prior open globe injuries . in delayed intervention , primary ocular repair , if needed , is often done within hours of the injury to stabilize the eye , while vitreoretinal surgery takes place up to one month later . this review analyzes recent publications and research in the management and outcomes of traumatic rds to suggest updated guidelines for the management of this condition , with particular attention as to whether vitreoretinal surgery should occur within the first 7 days after injury or later . the following search terms were entered into http://www.pubmed.gov/ ( us national library of medicine , national institutes of health ) :  ( retinal detachment / statistics and numerical data  [ mesh ] or  retinal detachment / surgery  [ mesh ] or  retinal detachment / therapy  [ mesh ] ) and  craniocerebral trauma  [ mesh ] . results were limited to the research studies conducted in humans within the past ten years ( 20062016 ) that are written in english . two independent reviewers analyzed all 70 articles and agreed that 24 of these articles were pertinent to this review . after extensive review of these 24 articles , it was mutually decided that 9 had data suitable to this review . articles were excluded if they did not discuss traumatic retinal detachment , if they did not separate outcome measures based on whether patients had retinal detachment versus other types of retinal pathology , or if they did not involve surgical intervention for retinal detachment . for individual consideration of the impact of time to intervention , articles were only included if they reported outcome measures individually for each patient or stratified patients by timing to intervention . outcome measures studied included percentage of patients with improved visual acuity postoperatively and percentage of patients with attached retina at follow - up . a pearson chi - square test was used to determine whether timing to intervention resulted in a significantly different number of patients with attached retina at follow - up . the timing variable for each study was coded in two groups , one with patients receiving intervention within 7 days including those who had concomitant open globe repair and rd repair and the other with patients receiving intervention greater than 7 days after presentation . all studies fit into these two categories except ehrlich and polkinghorne , which reported a mean time to intervention of 22.4 days , which was coded in the timing category as greater than 7 days to intervention . p values of less than 0.05 were considered statistically significant , and hazard ratios were conducted with a 95% confidence interval by the cox proportional - hazard analysis . statistical analysis was conducted using statistical package for the social sciences ( spss ) version 22.0 ( ibm ; chicago , il ) . most patients underwent primary closure promptly if necessary for open globe injury , but time to vitreoretinal intervention for retinal detachment varied . of the 9 included articles , 5 provided information on timing to intervention ( table 1 ) . ehrlich and polkinghorne reported a mean time to vitreoretinal intervention of 22.4 days ( range 386 days ) among a total of 19 adult patients and was therefore analyzed as greater than seven days before intervention . among the five articles , 171 patients in total underwent intervention within 7 days of diagnosis of trauma related rd , and 28 patients underwent intervention greater than 7 days after diagnosis of rd . of those with intervention within 7 days , 88 of those had vitreoretinal surgery 48 hours or less after diagnosis of rd [ 9 , 10 ] . nashed et al . reported on 88 that underwent retinal detachment repair at the same time as open globe repair within 8 hours of initial presentation . these patients were all included in the analysis . of note , none of these studies except nashed et al .   identified and separated patients by the timing of open globe injury repair , whether it was prior to vitreoretinal surgery or concomitant with it . a chi - square test of independence determined that the relationship between the timing of intervention and the number of patients with an attached retina at follow - up was not significant ;  ( 1 , n = 199 ) = 0.216 , p = 0.642 . no other factors such as concomitant open globe or type of surgical intervention were found to be statistically significant in regard to subsequent anatomic success at follow - up . a comparison of preintervention and postintervention best corrected visual acuity ( bcva ) can be found in table 3 . two of the studies included in our analysis provided visual acuities before and after surgery for each patient , and thus we compared the preoperative and postoperative visual acuities to determine if their vision improved , was stable , or deteriorated after intervention ( table 4 ) [ 8 , 10 ] . the surgical interventions in these two studies included both vitrectomy and scleral buckle placement . in 54% of patients , visual acuity ( va ) was improved after surgical intervention , whereas 36% of patients had a worsened va after surgery . 10% of patients had a stable va [ 8 , 10 ] . up to 32% of patients ultimately had no light perception , while up to 13% of patients achieved 20/20 va   ( table 3 ) . in sheard et al . 's study , 65% of pediatric patients receiving scleral buckle had improved va after intervention , 18% had worsened va , and 18% were stable . amongst the vitrectomy patients in the same study , 36% had improved va after intervention , 36% had worsened va , and 29% were stable . type of vitreoretinal intervention was reported for a total of 294 patients among the 9 included studies ( table 5 ) . 159 patients underwent vitrectomy alone , 32 had scleral buckle placement alone , and 34 had both vitrectomy and placement of a scleral buckle . the exact number of patients with adjuvant use of scleral buckle during vitrectomy was not reported in either of these articles ; therefore these treatment counts are not included in the totals above . there is insufficient data to assess whether the type of surgical intervention had an impact on either anatomical success or postoperative visual acuity . complication rates following vitreoretinal surgery for traumatic retinal detachment in these studies are detailed in table 6 . the vast majority of phakic eyes developed cataracts after surgical intervention [ 9 , 11 , 17 ] . development of secondary glaucoma was also a significant complication and in some cases required surgical intervention [ 10 , 15 ] . multiple investigators found that patients developed phthisis bulbi , with up to 30% of patients experiencing this complication in certain studies [ 5 , 810 , 12 ] . pvr was a significant finding postoperatively , as it was found in up to 56% of patients [ 5 , 8 , 12 , 15 ] . this review analyzes the available articles over the last 10 years since the use of small gauge vitrectomy which included a diverse population of patients with traumatic retinal detachment , including both pediatric and adult patients . notably , the mechanism of ocular injury , the extent of injuries , timing of rd development , and surgical management varied significantly between patients in the available studies . in our review , reattaching the retina within 7 days after trauma did not significantly affect the likelihood that the retina would remain attached at follow - up , nor did waiting over 7 days before vitreoretinal surgery affect anatomical success rates . for all studies , this was assessed at more than three months after the surgery . this review highlights a lack of literature regarding this topic in regard to the appropriate intervention in these cases with or without the presence of open globe injury , suggesting the need of additional studies to help identify these factors . there is insufficient data to assess if the type of vitreoretinal intervention affects anatomical success or postoperative visual prognosis . the available cases in the literature are limited and also represent a large mix of patients who had different mechanisms and extent of ocular trauma leading to many confounding factors in our analysis . current recommendations are trending towards earlier intervention to reduce the risk of extension of the retinal detachment and increased proliferation of the epiretinal membranes . further analysis of these cases should be performed in order to develop better guidelines as to the ideal time to repair these traumatic retinal detachments . however , this is not the only factor affecting visual potential because regardless of what time vitreoretinal surgery is performed , postoperative va varies widely . this makes it difficult to counsel patients about their expected visual outcome when they have traumatic retinal detachments . this inability to accurately predict postoperative va has led several investigators to study what factors influence final va . multiple studies support that a poorer va at presentation predicts a poorer final visual outcome [ 9 , 12 , 18 ] . attachment of the macula at presentation was associated with an improved visual outcome [ 9 , 10 ] . developing endophthalmitis conferred an inferior visual outcome in one study   but was not shown to have the same effect in another . recurrent retinal detachment predicted a worse visual outcome , as did total rd on presentation , retention of silicone oil in the eye , and development of pvr . the following factors were not shown to significantly influence visual outcome : an open globe injury , previous ocular surgery , lens injury , number and severity of retinal tears , presence of vitreous hemorrhage [ 9 , 14 , 16 ] , need for multiple vitreoretinal procedures , and whether the patient received scleral buckling or ppv [ 9 , 12 , 14 ] . most cases of redetachment after surgery were secondary to proliferative vitreoretinopathy [ 9 , 14 ] . wang et al . found that , in pediatric patients with traumatic rd , age , sex , location of injury , time between injury and rd , vitreous hemorrhage , and lens status did not predict anatomical success rate . however , poor preoperative va ( lp or worse ) , presence of pvr grade c or worse , detachment of the macula , total rd , and vitrectomy ( as opposed to scleral buckle ) are associated with a worse anatomical success rate . an important point to consider is that rd does not always occur immediately after trauma . other investigators have studied which patients are more likely to develop a retinal detachment after traumatic globe injury . studied open globe injuries and found that a visual ability to count fingers ( or worse ) , injury involving the sclera posterior to the limbus , and presence of vitreous hemorrhage all correlated with an increase rate of developing subsequent traumatic rd . they subsequently created a scoring system to predict the likelihood of a retinal detachment after open globe injury based on the presence of these characteristics . however their analysis did not make any recommendations regarding the management of these cases once they develop retinal detachments . pimolrat et al . also found that , in patients who require pars plana vitrectomy ( ppv ) after open globe injury , the presence of a rapid afferent pupillary defect was significantly associated with a worse visual acuity after vitrectomy . however , only 32% of the patients in this study had a rd , limiting its applicability to patients who have already developed a rd . while surgical intervention for traumatic retinal detachment can be vision - saving , it is not without its risks , as detailed in table 5 . pvr is a major concern after surgery for rd , with up to 56% of patients developing this complication . as discussed previously , pvr is a significant risk factor for recurrent retinal detachment , so this complication is of particular importance . in a study of 28 patients treated with cryobuckle only for retinal detachment due to retinal dialysis this may indicate that cryobuckle alone is associated with a decreased risk of pvr development . however , this study had a small population and was limited to only patients with traumatic rd with retinal dialysis , which is often amenable to repair with buckle only . this is in contrast to most other traumatic rds which have limited success with buckle - only repair . endophthalmitis rates were as low as 3.4% when surgical intervention for rd repair was performed within 8 hours , whereas when timing of surgery is not taken into account , other authors report that ocular trauma resulted in endophthalmitis in up to 13% of cases . these results suggest that other important outcome measures are also related to timing of vitreoretinal intervention , and further studies delineating the risks and benefits of early surgical intervention should be pursued . traumatic retinal detachments are challenging and decisions should be individualized ; however further analysis to help identify which surgical techniques improve outcome should be undertaken . there is insufficient data to assess if early vitreoretinal surgery to repair traumatic rds leads to significantly higher reattachment rates at long - term follow - up and improved visual outcomes for patients . common adverse outcomes after vitreoretinal surgery for traumatic rd include pvr , cataracts , secondary glaucoma , phthisis bulbi , and endophthalmitis . preliminary studies indicate that endophthalmitis rates may be lower when early vitreoretinal surgery is performed . the information in this review suggests it is too soon to determine if vitreoretinal surgery for repair of traumatic retinal detachment should be performed within 7 days of the inciting event , and further studies should focus on prospectively determining the effect of timing to intervention particularly in cases of concomitant open globe injuries on clinical outcome variables and complication rates .
traumatic retinal detachments are a significant cause of morbidity . there are currently no evidence - based guidelines on the appropriate time to perform vitreoretinal surgery to repair a traumatic retinal detachment 
 . early intervention , within seven days of the inciting trauma , may decrease proliferative vitreoretinopathy and postoperative endophthalmitis . 
 later intervention may yield a reduced risk of inflammation and hemorrhage , particularly in cases of concomitant open globe injuries . 
 this article reviews the literature on the management of retinal detachments associated with ocular trauma from the years 2006 to 2016 . 
 particular focus was placed on the timing of surgery , concomitant open globe injury , anatomical success rates , visual acuity , and complication rates . in this review , 
 anatomical success was not significantly related to timing of intervention when compared between early and delayed intervention in eyes with and without concomitant open globe injuries . 
 visual acuities postoperatively varied widely despite timing of intervention due to the large variation in mechanism and extent of ocular injuries . 
 proliferative vitreoretinopathy was a common complication . 
 preliminary data indicate that endophthalmitis rates may be lower when early vitreoretinal surgery is performed . 
 there is insufficient data to conclude whether early or delayed surgery leads to improved outcomes , highlighting the need for further research in this domain .