Frequency of Rhegmatogenous Retinal Detachment after Intravitreal Therapy in Neovascular Age-Related Macular Degeneration

Abstract

To identify characteristics of neovascular age-related macular degeneration (nAMD) patients undergoing pars plana vitrectomy (PPV) after rhegmatogenous retinal detachment (RRD), including changes to injection intervals. Single-center retrospective, consecutive review. All patients with RRD receiving anti-vascular endothelial growth factor treatment for nAMD from January 1, 2014, through October 30,2018. Billing codes were used to identify RRD that occurred within 90 days of a previous intravitreal injection for nAMD. Outcome measures included the quadrant of the retinal break(s), visual acuity at the time of RRD and final follow-up, and postoperative injection frequency. An exact total of 203 000 intravitreal injections for nAMD were administered. Seventeen eyes from 17 patients demonstrated RRDs, giving a rate of 1 RRD per 11 941 intravitreal injections (0.0084%) within 90 days of intravitreal injection. Patients received a mean of 27.56 injections in the superotemporal quadrant before RRD. Of known retinal breaks, the superotemporal quadrant was involved most frequently (10 of 16 eyes [62.5%]). Six patients (35.3%) required a second surgery. Of patients requiring postoperative injections, the average interval increased from 7.18 weeks to 9.17 weeks after surgery. Eleven of 17 patients (64.7%) either increased their injection intervals or required no further injections, 3 maintained similar intervals, and 3 decreased intervals. The average number of injections in the 6 months before RRD (n= 84) and the 6 months after the first injection after PPV (n= 47) was 4.94 ± 1.89 and 2.76 ± 2.44, respectively (P= 0.009). Based on these results, the 90-day rate of RRD in nAMD patients receiving intravitreal injections is low. Rhegmatogenous retinal detachments in these patients may be more difficult to repair. Although many physicians worry about injection frequency in vitrectomized eyes because of a presumed increased medication clearance, this study found that most patients received fewer injections after surgery.