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When electing to have intravitreal injections, there are several risks and rewards to consider. You will preserve your vision but you also risk having potential retinal detachments among other complications. Is this a small issue or something more severe?

When it comes time to decide on treatments for macular degeneration, there are some risks and benefits for two of the main macular degeneration treatments you can consider [1]. One option would be anti-VEGF therapy where a doctor injects factors into your eye in order to prevent the growth of future blood vessels from overcrowding your macula and retina [2]. The other would be laser photocoagulation and this would be less invasive and only require lasers to burn holes into your capillaries to stop blood vessels from forming [3]. It is less effective than anti-VEGF therapy so here, we will only consider some of the side effects to worry about when you are deciding on anti-VEGF therapy [4].  More specifically, the risk of retinal detachment after getting intravitreal injections. 

When Macular Degeneration Treatment Fails 

When it comes to intravitreal injections, there are a number of side effects and possible complications that patients need to be aware of. With anti-VEGF therapy, patients can experience things like increased intraocular pressure, dangerous eye infections and hemorrhage in the eye as well as the chance of having retinal detachments. [5]

Thankfully, in most situations, intravitreal injections are very safe and the frequency of these complications is quite low. Retinal detachments are very rare and only occur 0.6 percent of the time [6]. The exact reason behind why these retinal detachments occur is unknown but researchers speculate that the surge of fluid in the eye can weaken the posterior wall of the eye chamber leading to an increased chance of having the retina detach while others feel it is more likely just due to improper surgical technique. As techniques are improved and imaging studies are becoming more used, the future prevalence of retinal detachments is likely to drop even further. 

You can suspect that you have a retinal detachment when you feel as if a curtain has fallen over your eye. You may have visual symptoms like bright flashes of light, inabilities to focus on objects and then an eventual complete darkening of your visual field. It is something that can be fixed but an unfortunate thing is that after one retina detaches, you are predisposed to having retinal detachments in the future. [7]

Retinal Detachment After Intravitreal Injections Treatments

Once a retinal detachment has occurred, the way to manage it is much like how you will approach it as if it was a normal retinal detachment not related to intravitreal injections. This is a fairly common event in society and occurs in 3 percent of the general population [8]. The only risk with intravitreal injections is the fact that when you continue to have injections, there is the possibility of increasing the number of retinal detachments as the scar tissue in your inner eye chamber builds. 

Treatment is not as simple as simply reattaching the retina depending on the type of retinal detachment. There are three types of retinal detachments to consider: rhegmatogenous, tractional and exudative separations. Our focus is on the rhegmatogenous process because this is the type caused by persistent trauma to the eye. Most of this category of retinal detachments are due to the posterior detachment of the retina which may even occur without obvious symptoms. There is a risk of developing retina breaks where more parts of the retina ripping off because of the added tension on this small component. This can occur in 15 percent of cases of posterior dislocations of the retina. Another risk factor is age and up to 40 percent of the population will naturally have a posterior dislocation of the retina by their 70's and they may not even be aware of it due to symptoms. 

When the detachment has occurred, you need to see a specialist. If that is not immediately possible, lie down on your bed with your head positioned so the eye with the visual defect is closest to the pillow. This will prevent from the retinal detachment to progress further into the macula. 

Once you see an ophthalmologist, your treatment depends on the severity of what you are experiencing. If a retinal tear has already occurred, physicians will need to perform a type of laser therapy or cryotherapy to create scar tissue to have the retina pieces reattach. This is a very efficient operation and is almost 100 percent successful but this does not guarantee that you will be free from further breakage in the future. 

If the retina is detached only, the surgery to reattach it to the surrounding tissue is very similar to what was described for retinal breaks. Scleral buckling and vitrectomies are two additional measures to ensure that the retina does not detach in the future. Retina detachments involving the macula are far worse to treat and time is a critical factor in determining how effective therapy can be. Studies show the best results are realized if the surgery is performed within five days. The longer the detachment lasts, the worse the visual acuity outcome will be. Patients will then be discharged and given antibiotics and steroids to help reduce swelling and return visual fields. 

All in all, this is simply a cautionary tale to inform you about what to do when macular degeneration treatment fails. These risks are quite small, and even if retinal detachment after intravitreal injections is possible after macular degeneration treatment,  it is something to not worry about when you are dealing with wet macular degeneration. 

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