A 54-year-old diabetic with severe non-proliferative retinopathy and fibrovascular proliferation receives a single intravitreal bevacizumab injection. Ten days later he returns with sudden profound loss of vision. B-scan shows a fresh tractional retinal detachment involving the macula that was not present before injection. What is the most likely mechanism?
- A Direct toxic effect of bevacizumab on the photoreceptors
- B Sterile inflammation causing exudative retinal detachment
- C Contraction of the neovascular complex and posterior hyaloid following rapid VEGF suppression ✓
- D Progression of the underlying diabetes unrelated to the injection
Correct answer: C. Contraction of the neovascular complex and posterior hyaloid following rapid VEGF suppression
Explanation
Anti-VEGF agents cause rapid regression of neovascular tissue, and the regressing fibrovascular membrane contracts, transmitting traction through the adherent posterior hyaloid to the retina. This can precipitate tractional retinal detachment, particularly when fibrovascular proliferation is extensive and tightly adherent to the retina. It is the reason some surgeons combine early vitrectomy with anti-VEGF in such eyes rather than injecting alone.
Reference: Ryan's Retina, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.