Rhegmatogenous Retinal Detachment after Intravitreal Injection of Anti-Vascular Endothelial Growth Factor

Purpose: To report the rate, risk factors, and outcomes of rhegmatogenous retinal detachment (RRD) after intravitreal injection of anti-vascular endothelial growth factor medications. Design: Single-center, retrospective, consecutive review. Participants: All patients receiving ranibizumab, bevacizumab, or aflibercept for neovascular age-related macular degeneration or retinal vein occlusion between October 1, 2014, and October 1, 2017. Methods: The total number of eyes and injections were determined from billing codes. Rhegmatogenous retinal detachment patients were determined from billing records and confirmed with chart review. Main Outcome Measures: Rate of retinal detachment and visual acuity outcomes. Results: A total of 180 671 intravitreal injections in 12 718 unique patients were included. An RRD occurred in 24 patients within 3 months after injection, giving a rate of 1 RRD per 7532 intravitreal injections (0.013%) and 1 RRD per 530 patients (0.19%). No association was found between RRD risk after injection and diagnosis (P = 0.54), physician experience (P = 0.23), injection site (P = 0.41), caliper use (P = 0.75), or 31- versus 30-gauge needle use (P = 0.18). A retinal tear was found located in the quadrant of the injection site (within 1.5 clock hours of the injection) in 15 of 24 patients (62.5%; P < 0.0001). At the time of RRD diagnosis, the macula was attached in 9 patients (37.5%). Interventions for RRD repair included pars plana vitrectomy (PPV; 15 patients), combined scleral buckle and PPV (4 patients), pneumatic retinopexy (3 patients), and laser or cryotherapy alone (2 patients). Single-surgery success rate was 54.2%, with 54.5% of recurrent detachments caused by proliferative vitreoretinopathy. Average loss from visual acuity recorded at the visit before diagnosis of RRD was 1.0 line for maculaon detachments versus 6.8 lines for macula-off detachments (P = 0.027) at final follow-up (average, 16.3 months). Conclusions: Retinal detachment after intravitreal injection is uncommon, with a rate of approximately 1 in 7500 injections. Macular status at the time of RRD diagnosis significantly affects visual outcomes. (C) 2019 by the American Academy of Ophthalmology