- Design
- Systematic review and meta-analysis of proportions
- Population
- 787,849 anti-VEGF injections in 9 studies
- Primary outcome
- Rhegmatogenous retinal detachment
- Effect
- 0.012% per injection (0.009% to 0.015%); 0.08% per eye (0.02% to 0.31%)
This meta-analysis pooled studies reporting retinal detachment after intravitreal anti-VEGF for neovascular AMD, diabetic macular oedema, vein occlusion, proliferative diabetic retinopathy and myopic neovascularisation. Nine studies with 787,849 injections gave 92 rhegmatogenous detachments: 0.012% per injection (95% CI 0.009% to 0.015%), about 1 in 8,675. The risk within 90 days was similar.
Per eye, the risk was 0.08% (0.02% to 0.31%), about 1 in 1,250 eyes, though with wider uncertainty and an average of only 13.8 injections per eye — fewer than many patients receive. One study of severe proliferative diabetic retinopathy reported tractional detachment after 3.6% of injections, reflecting fibrovascular contraction rather than the injection itself.
These figures are useful for consent. For patients facing years of injections, the per-eye number is more meaningful than the per-injection one, and it will rise with exposure.
- Quote about 1 in 8,700 per injection and about 1 in 1,250 per eye when consenting
- Tell long-term patients that cumulative risk rises with the number of injections
- In severe proliferative diabetic retinopathy, warn about tractional detachment after anti-VEGF
- Teach every patient the warning symptoms of detachment and how to return urgently
Why it matters
It gives numbers for a consent conversation that is usually vague.
Don't overread it
Certainty is low, and the per-eye estimate is based on fewer injections per eye than many patients receive.
The statistics, in plain English
A per-injection risk of 0.012% is 12 in 100,000. Low heterogeneity (I² 14%) means studies agreed. The per-eye interval is wide (0.02% to 0.31%), so that estimate is less secure.
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