Direct posterior retinal injury caused by intravitreal injections: management and outcomes from a vitreoretinal perspective

To report the clinical presentation, management, complications and outcomes after retinal injuries caused by intravitreal injections. Retrospective case series of twelve eyes presenting with visual deterioration due to vitreoretinal complications secondary to trauma caused by intravitreal injections. Detailed ocular history, clinical examination, vitreoretinal complications, management, final anatomical and visual outcomes are documented. We observed 12 cases of direct retinal trauma by the needle tip of intravitreal injection. All retinal injuries were located in the temporal mid-periphery, usually near the inferior arcade. Of the twelve patients, four eyes developed a retinal detachment, all with proliferative vitreoretinopathy, six had vitreous hemorrhage, and two eyes presented with a focal chorioretinal atrophic lesion. The patients either underwent surgical procedure or were closely monitored after the injury. The surgical intervention was successful in terms of anatomical outcomes in all cases. Ten eyes had a final visual acuity similar to baseline while two eyes experienced visual deterioration during a follow up of at least 6 months. Direct retinal injury with the intravitreal injection needle is a rare but possibly underreported adverse event. Early detection of these complications, especially if associated with retinal detachment, is important for timely and appropriate management to avoid permanent loss of vision.