Abstract
Purpose :
Rhegmatogenous retinal detachment (RRD) is a known complication of intravitreal anti-vascular endothelial growth factor (VEGF) agents. No study has explored characteristics associated with RRD in patients receiving anti-VEGF treatment for neovascular age-related macular degeneration (NVAMD). We hypothesize that these patients experience an increased rate of detachments at the site of injection as well as a decrease in post-operative injection frequency.
Methods :
We performed a single-center retrospective, consecutive review of NVAMD patients with RRD while receiving anti-VEGF treatment from 1/1/2014 - 10/30/2018. Patients with concurrent retinal disease or those not actively receiving injections at time of RRD were excluded. Outcome measures included the quadrant of the retinal break(s), visual acuity (VA) at time of RRD and final follow-up, and post-operative injection frequency. Two-tailed Student’s t-test was used for statistical analysis.
Results :
17 eyes from 17 patients (8 M, 9 F) were examined. Patients received an average of 27.56 injections in the superotemporal (ST) quadrant prior to RRD onset. Average age at time of RRD was 78.8 years. Of known retinal breaks, the ST quadrant was most frequently involved (10 of 16 eyes, 62.5%, p < 0.04). 8 patients underwent pars plana vitrectomy (PPV) and nine underwent PPV with scleral buckle (SB). Average VA at time of RRD presentation was 1.07 logMar (20/230 Snellen) and at last follow-up (34.15 months) was 1.04 logMar (20/220). The average days between the last injection and RRD was 21.1. Injection type was not associated with increased or decreased time to RRD (p > 0.5). The average number of days between RRD repair and the first post-operative injection was 158.4 days, with 4 patients requiring no injections post-operatively. Of patients requiring post-op injections, average interval increased from 7.5 weeks pre-op to 10.2 weeks post-op (p < .03). 11 of 17 (64.7%) patients increased their injection interval, 3 maintained similar intervals, and 3 decreased intervals.
Conclusions :
Based on these results, the quadrant involved in this patient population does not seem to differ from the normal distribution of retinal breaks in all eyes with RRD. While many physicians worry about injection frequency in vitrectomized eyes due to a presumed increased med clearance, this study found that the majority of patients required less injections postoperatively.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.