Retinal detachment after anti-VEGF injection: about 1 in 8,700 injections

A meta-analysis of twelve studies and 834,814 intravitreal anti-VEGF injections quantified the risk of retinal detachment — the number every patient asks about at consent, usually answered with a shrug.

Rhegmatogenous retinal detachment occurred at a pooled rate of 0.012% per injection (95% CI 0.009 to 0.015), roughly 1 in 8,675. Expressed per eye over a treatment course the risk was 0.08%, about 1 in 1,250, which is the more honest figure for a patient facing years of injections. Risk did not vary by injection number, setting or provider. Separately, in severe proliferative diabetic retinopathy the tractional detachment risk was far higher (3.6%), reflecting the underlying disease rather than the needle.

The practical value is a real number for consent: rhegmatogenous detachment is rare per injection, modest but non-zero per eye over time, and the high-risk group is severe PDR, where the detachment is disease-driven.

• Rhegmatogenous detachment ~0.012% per injection (about 1 in 8,675)
• Per-eye risk over a course ~0.08% (about 1 in 1,250) — the number for consent
• No difference by injection number, centre or provider type
• Severe PDR carries a much higher tractional detachment risk (3.6%), disease-driven

The statistics, in plain English

The per-injection and per-eye figures answer different questions: per-injection risk (1 in 8,675) reassures about a single visit, while per-eye risk (1 in 1,250) reflects cumulative exposure over years and is what a patient starting long-term therapy should hear. Low-certainty evidence and a mean of only 13.8 injections per eye in the data mean the lifetime per-eye risk is probably underestimated.

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