Intravitreal anti-VEGF injection is the most frequently performed intraocular procedure in the world, and retinal detachment has remained one of its least well quantified complications. This meta-analysis pooled 12 studies, 834,814 injections and 119 detachment events.
Rhegmatogenous retinal detachment occurred in 0.012% of injections (95% CI 0.009-0.015), about 1 in 8,675, with low heterogeneity. Restricting to events within 90 days gave a consistent 0.013%. The per-eye figure was 0.08% (95% CI 0.02-0.31), roughly 1 in 1,250 eyes, with wider uncertainty. Subgroup analyses found no difference by injection volume, single versus multicentre setting, indication, injection provider or risk of bias. Separately, one study in severe proliferative diabetic retinopathy reported tractional detachment in 3.6%, about 1 in 28 — a different mechanism reflecting fibrovascular contraction rather than a procedural complication.
The authors make an important observation about which figure to quote. The per-eye risk is the one relevant to a patient facing years of treatment, and even that likely understates real exposure: the contributing studies averaged 13.8 injections per eye, well below what long-term nAMD or diabetic macular oedema patients actually receive. Certainty was rated low.
- Rhegmatogenous detachment 0.012% per injection — about 1 in 8,675
- Per-eye risk 0.08% — about 1 in 1,250, with wider uncertainty
- No difference by indication, provider, setting or injection volume
- Severe PDR: tractional detachment 3.6%, a different mechanism entirely
The statistics, in plain English
The gap between the two figures is arithmetic, not disagreement: multiple injections per eye accumulate risk, so per-eye risk is roughly per-injection risk multiplied by the number of injections. The per-eye interval, 0.02% to 0.31%, is fifteen-fold wide because eye-level denominators were reported by few studies. The tractional detachment figure of 3.6% belongs to severe proliferative disease and its natural history, and quoting it as a procedural risk would badly mislead a patient.
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