Reported Retinal Detachment in Anti-VEGF-Treated Retinopathy of Prematurity: A Systematic Review and Meta-Analysis

Objectives: To estimate the incidence of reported retinal detachment (RD) after primary anti-vascular endothelial growth factor (anti-VEGF) treatment for retinopathy of prematurity (ROP) and to explore study-level factors associated with RD incidence. Methods: PubMed, EMBASE, Cochrane Library, and Web of Science were searched up to 24 May 2026, for English-language studies reporting RD outcomes after anti-VEGF monotherapy for ROP. Pooled incidence was estimated with a random-effects model using Freeman-Tukey double arcsine transformation. Heterogeneity, subgroup differences, publication bias, and leave-one-out sensitivity were assessed. Results: Twenty-seven studies (5598 eyes; 135 RD events) were included, comprising twelve case series, thirteen cohort studies, and two randomized controlled trials; thus, the evidence was predominantly retrospective. The pooled RD incidence was 1.4% (95% CI, 0.5-2.7%; I² = 80.8%). The estimate remained stable on leave-one-out sensitivity analysis; the exclusion of Tong et al. markedly reduced heterogeneity. Higher RD incidence was observed in Asian studies, single-center studies, and studies with predominantly Zone I ROP or aggressive ROP (AROP). Incidence varied by postmenstrual age at treatment, gestational age, birth weight, and anti-VEGF agent. No significant publication bias was detected. Conclusions: RD after primary anti-VEGF therapy for ROP is uncommon but sight-threatening, with higher incidence associated with greater disease severity and postmenstrual age. Prolonged, risk-stratified follow-up is warranted for infants with Zone I or AROP. Standardized RD definitions, subtype classification, and severity-adjusted prospective comparisons are needed.