Rhegmatogenous Retinal Detachment May Be a Rare Complication of Anti-VEGF Injection

Mark Gillies, MBBS, PhD

Rhegmatogenous retinal detachment is a rare complication of intravitreal injections with anti-VEGF in routine clinical practice and was associated with poor visual outcomes at 1 year, according to a retrospective analysis of data from the Fight Retinal Blindness! Registry.

“Cases with RRD lost 3 lines of vision on average compared with the prior RRD VA and had significantly fewer injections than matched controls over the year after the RRD,” wrote study author Mark Gillies, MBBS, PhD, Save Sight Institute, The University of Sydney.

The study aimed to report the estimated incidence, probability, risk factors and 1-year outcomes of rhegmatogenous retinal detachment in eyes receiving anti-VEGF injections for various retinal conditions in routine clinical practice. It was a retrospective analysis of data from the prospectively designed observational outcomes registry in the Fight Retinal Blindness! project.

It included the yes of participants starting intravitreal injections of VEGF inhibitors, including ranibizumab, aflibercept, or bevacizumab, for neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), or retinal vein occlusion (RVO) between January 2006 and December 2020. All eyes that developed rhegmatogenous retinal detachment within 90 days of intravitreal injection were defined as cases with rhegmatogenous retinal detachment and were then matched with control eyes.

Investigators measured the estimated incidence, probability, and hazard ratios (HRs) of rhegmatogenous retinal detachment using Poisson regression, Kaplan-Meier survival curve, and Cox proportional hazards models. Meanwhile, locally weighted scatterplot smoothing curves were used to compare visual acuity between cases and matched controls. The main outcome measures were the estimated incidence of rhegmatogenous retinal detachment.

The study identified 16,915 eyes of 13,792 patients who collectively received 265,781 intravitreal injections over the 14-year period. A total of 36 eyes were reported to develop rhegmatogenous retinal detachment over the study period.

Data show the estimated incidence per year per 1000 patients was 0.77 (95% confidence interval [CI], 0.54 - 1.07) and per 10,000 injections was 1.36 (95% CI, 0.95 - 1.89). Investigators noted the probability of rhegmatogenous retinal detachment did not significantly increase at each successive injection (P = .95) with the time of follow-up.

Older patients were at a higher risk of rhegmatogenous retinal detachment for every decade increase in age (HR, 1.81; 95% CI, 1.21 - 3.62, P <.01). Meanwhile, individuals with good presenting visual acuity were at a lower risk (HR, 0.85 [95% CI, 0.70 - 0.98] for every 10-letter increase in VA, P = .02).

Investigators added that neither the type of retinal disease (P = .52) nor the VEGF inhibitor (P = .09) was significantly associated with rhegmatogenous retinal detachment risk.

The abstract, “Incidence, RIsk Factors, and Outcomes of Rhegmatogenous Retinal Detachment after Intravitreal Injections of Anti-VEGF for Retinal Diseases: Data from the Fight Retinal Blindness! Registry,” was published in Ophthalmology Retina.