- Design
- Systematic review and meta-analysis of proportions
- Population
- 834,814 anti-VEGF injections in 12 studies
- Primary outcome
- Rhegmatogenous retinal detachment risk
- Effect
- 0.012% per injection (0.009-0.015%); 0.08% per eye (0.02-0.31%)
A systematic review and meta-analysis pooled 12 studies covering 834,814 intravitreal anti-VEGF injections for macular degeneration, diabetic macular oedema, vein occlusion, proliferative diabetic retinopathy and myopic choroidal neovascularisation.
Across nine studies (787,849 injections, 92 events), rhegmatogenous retinal detachment risk was 0.012% per injection (95% CI 0.009-0.015%), about 1 in 8,675. Risk within 90 days was similar. Per eye it was 0.08% (0.02-0.31%), about 1 in 1,250, with more uncertainty. Risk did not differ by indication or injector. One study in severe proliferative retinopathy reported tractional detachment in 3.6%.
Patients on long-term injections ask about cumulative risk, and consent forms often quote figures without a firm source. These pooled numbers give a defensible answer.
The per-eye figure matters most, and contributing eyes averaged only 13.8 injections, fewer than many patients receive, so lifetime risk is likely higher.
- Quote about 1 in 8,700 per injection and about 1 in 1,250 per treated eye when consenting.
- Explain that risk accumulates with more injections.
- Counsel patients with severe proliferative retinopathy separately about tractional detachment.
- Teach warning symptoms: new floaters, flashes or a curtain over vision.
Why it matters
Consent for the commonest intraocular procedure can now cite a pooled per-injection and per-eye risk rather than a guess.
Don't overread it
Certainty was low, and the per-eye estimate comes from eyes with fewer injections than many patients receive.
The statistics, in plain English
The per-injection estimate is precise because it rests on nearly 800,000 injections and low heterogeneity. The per-eye interval, 0.02% to 0.31%, is much wider, meaning anything from about 1 in 5,000 to 1 in 300 eyes is compatible with the data.
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