Central retinal vein occlusion following intravitreal injections: a case series highlighting multifactorial risk.

INTRODUCTION: Intravitreal injections are standard treatment for various manifestations of age-related macular degeneration (AMD) but are associated with rare complications, including central retinal vein occlusion (CRVO). This report describes three cases of CRVO following intravitreal injections in patients with AMD. METHODS: Retrospective case series describing three patients with AMD who developed CRVO after intravitreal injections. RESULTS: CRVO occurred after ranibizumab (Lucentis, South San Francisco, CA), brolucizumab (Beovu, Novartis, Basel, Switzerland), and pegcetacoplan (Syfovre, Apellis, Waltham, MA) injections. All patients had multiple systemic vasculopathic risk factors. No intraocular inflammation or vasculitis was observed on examination, and fluorescein angiography was not performed. Visual outcomes were poor despite anti-VEGF treatment. None of the three patients developed neovascular glaucoma under our observation. The timing relationship between injection and CRVO varied, and causality could not be established. CONCLUSION: CRVO may occur after intravitreal injections across different drug classes, even with agents that have low inflammatory potential. These cases highlight the multifactorial nature of this event and the importance of considering systemic vasculopathy when evaluating post-injection complications.