Incidence, Risk Factors, and Outcomes of Rhegmatogenous Retinal Detachment after Intravitreal Injections of Anti-VEGF for Retinal Diseases
Pierre‐Henry Gabrielle, Vuong Nguyen, Louis Arnould, Francesco Viola, Javier Zarranz‐Ventura, Daniel Barthelmes, Catherine Creuzot‐Garcher, Mark C. Gillies, David Squirrell, Jagjit S. Gilhotra, C. Brooijmans, Odette A. M. Tigchelaar-Besling, Amy Cohn, Fred K. Chen, A McGeorge, Sarah E. Welch, Nandor Jaross, P. Peters, Richard Barry, I. W. McLean, Tremeur Guillaumie, A. Miri, Jean‐François Korobelnik, Pierre‐Henry Gabrielle, Michel Weber, Bouteraa Walid, Sarah Tick, S. Valen, Andy P. Field, Sanjeewa Wickremasinghe, C. Dayajeewa, John A. Wells, Rohan W. Essex, Adrian Dunlop, K Michalová, C. M. Ng, Stephanie Young, G. Mimoun, C. Generic, Robyn H. Guymer, Pablo Carnota, C. Torres Borrego, R. Dolz Marco, Roberto Gallego‐Pinazo, Jordi Esteban, A. García Layana, M. Saenz-de-Viteri, Joël Uzzan, R. Ferrier, John Ah‐Chan, Lu‐Ping Chow, H Steiner, Ali Amini, G. Clark, Nadia Wittles, P. Windle, J. R. Vingerling, Colin Clement, Mark C. Gillies, Anna Hunt, P. Beaumont, Lynne J. Cottee, Karen Lee, Heather G. Mack, Z. Louw, Jed Lusthaus, Jian Chen, John Landers, Kathryn J Billing, Nilanjan Saha, Stewart Lake, Dania Qatarneh, Russell Phillips, M. Perks, Karim Bañon, Mercè Guarro, G. Londoño, Cynthia Rethati, Laura Sararols, J. Suarez, Francesco Viola, Sioe Lan Oei, Samantha Fraser‐Bell, R. Montejano-Milner, Carolina Arruabarrena, Edwin K. P. Chong, Sean Lal, A. Higueras, FJ ASCASO, Ana Boned Murillo, M Díaz, Guillermo Pérez Rivasés, S. Alforja Castiella, Carolina Bernal-Morales, Ricardo P. Casaroli‐Marano, Marc Figueras‐Roca, Jordi Izquierdo-Serra, A. Moll Udina, Alba Parrado‐Carrillo, Javier Zarranz‐Ventura
Abstract
PURPOSE: To report the estimated incidence, probability, risk factors, and 1-year outcomes of rhegmatogenous retinal detachment (RRD) in eyes receiving intravitreal injections (IVTs) of VEGF inhibitors for various retinal conditions in routine clinical practice. DESIGN: Retrospective analysis of data from a prospectively designed observational outcomes registry: the Fight Retinal Blindness! PARTICIPANTS: Eyes of patients starting IVTs of VEGF inhibitors (ranibizumab, aflibercept, or bevacizumab) for neovascular age-related macular degeneration, diabetic macular edema, or retinal vein occlusion from January 1, 2006, to December 31, 2020. All eyes that developed RRD within 90 days of IVTs were defined as cases with RRD and were matched with control eyes. METHODS: Estimated incidence, probability, and hazard ratios (HRs) of RRD were measured using Poisson regression, Kaplan-Meier survival curve, and Cox proportional hazards models. Locally weighted scatterplot smoothing curves were used to compare visual acuity (VA) between cases and matched controls. MAIN OUTCOME MEASURES: Estimated incidence of RRD. RESULTS: We identified 16 915 eyes of 13 792 patients who collectively received 265 781 IVTs over 14 years. Thirty-six eyes were reported to develop RRD over the study period. The estimated incidence (95% confidence interval [CI]) per year per 1000 patients and per 10 000 injections was 0.77 (0.54-1.07) and 1.36 (0.95-1.89), respectively. The probability of RRD did not significantly increase at each successive injection (P = 0.95) with the time of follow-up. Older patients (HR [95% CI] = 1.81 [1.21-3.62] for every decade increase in age, P < 0.01) were at a higher risk of RRD, whereas patients with good presenting VA (HR [95% CI] = 0.85 [0.70-0.98] for every 10-letter increase in VA, P = 0.02) were at a lower risk. Neither the type of retinal disease (P = 0.52) nor the VEGF inhibitor (P = 0.09) was significantly associated with RRD risk. 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. CONCLUSIONS: Rhegmatogenous retinal detachment is a rare complication of VEGF inhibitor IVT in routine clinical practice with poor visual outcomes at 1 year.