JUN 17, 2019
Comprehensive Ophthalmology, Retina/Vitreous
This paper reports the rate, risk factors and outcomes of rhegmatogenous retinal detachment (RRD) after anti-VEGF injections.
Study design
This retrospective consecutive review included 12,718 patients who received 180,671 intravitreal injections. These patients received ranibizumab, bevacizumab or aflibercept for neovascular AMD or retinal vein occlusion during a 3-year period.
Outcomes
During the 3 months after intravitreal injections, there were only 24 cases of RRD and the overall rate of RRD was extremely low (1 RRD per 7,532 injections). A majority of detachments (62.5%) had a retinal tear within 1.5 clock hours of the injection site and 37.5% were macula-involving. The single surgery success rate for these cases was low (54.2%) and the most common reason for reattachment failure was proliferative vitreoretinopathy. The risk of post-injection RRD did not correlate with injection site, caliper use, needle gauge or physician experience.
Limitations
The single surgery success rate was low in this study. This, combined with the retrospective nature of the study, means it may be difficult to extrapolate and identify possible risk factors. Treatment of RRD, when applicable, was also not randomized to the different interventions; 3 cases were treated with pneumatic retinopexy while others received a scleral buckle or vitrectomy. This may have contributed to the low single surgery success rate.
Clinical significance
Retinal detachment following intravitreal injection is rare, with a rate of approximately 1 in 7,500 injections. It is, however, a possible complication and should be routinely discussed in the informed consent along with other risks such as endophthalmitis. Macular status at the time of RRD diagnosis significantly affects visual outcomes. Since a good number of cases in this series involved the macula, advising patients of the signs and symptoms of retinal detachment after injections may help facilitate earlier evaluation and treatment.