Intravitreal Therapy in Adults Aged ≤50 Years: Etiologic Spectrum, Treatment Patterns and Visual Outcomes in a...

Background: Intravitreal injections (IVI) are widely used for the management of retinal diseases, yet younger adults are underrepresented in clinical trials and real-world reports. Data on the etiologic distribution and treatment patterns of IVI in patients aged ≤50 years remain limited. This study aimed to characterize the indications, treatment strategies, and visual outcomes of IVI in this age group. Material and Methods: Retrospective, single-center observational study including adults aged 18-50 years who received IVI between January 2020 and December 2023 at a tertiary referral hospital in Spain. Demographic data, diagnosis, treatment modality, regimen, number of injections and best-corrected visual acuity (BCVA) were collected. One eye per patient was included for analysis. Visual outcomes were assessed as change in logMAR BCVA between baseline and final follow-up. Results: A total of 122 patients were included. The most frequent indications were diabetic macular edema (29.5%), macular neovascularization of various etiologies (21.3%), retinal vein occlusion (13.9%) and uveitis (9.8%). Anti-vascular endothelial growth factor (anti-VEGF) agents were used in 80.3% of eyes, corticosteroids in 6.6% and combination therapy in 13.1%. The mean number of injections per patient was 6.0 ± 5.3 over a mean follow-up of 3.0 ± 2.5 years. Overall BCVA improved significantly from 0.50 ± 0.59 to 0.38 ± 0.50 logMAR (p = 0.012). Conclusions: IVI in adults ≤ 50 years is uncommon but encompasses a broad etiologic spectrum. Diabetic macular edema and macular neovascularization of diverse etiologies were the leading indications. Anti-VEGF therapy represented the main treatment modality in this cohort.