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American Society of Retina Specialists Meeting
August 30, 2012
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Oral antibiotic use may be linked to elevated risk of retinal detachment

LAS VEGAS — Use of oral fluoroquinolones may be strongly correlated with an increased risk of retinal detachment, according to a large study presented here.

“There’s likely an effect between acute oral fluoroquinolone use and retinal detachment, with up to 4% of all detachments possibly attributed to this association. Confirmatory studies are needed but it still may be prudent to alert patients taking fluoroquinolones of the symptoms of detachment and ask them to seek attention if these symptoms develop,” David Maberley, MD, told colleagues at the American Society of Retina Specialists meeting.

Fluoroquinolone use has been associated with tendon rupture and may have a similar effect on vitreal collagen, Maberley said.

The case-control study included 4,384 patients diagnosed with retinal detachment and 43,840 healthy age-matched controls. Records were collected from a British Columbia Ministry of Health database.

Investigators assessed all oral fluoroquinolone use in the 1 year before retinal detachment diagnosis. A sensitivity analysis of two drugs not linked to retinal detachment, oral β-lactam antibiotics and short-acting β-agonists, was undertaken to validate the fluoroquinolone findings.

Study results showed that patients using fluoroquinolones concurrently with diagnosis had a 5.55-times greater risk of retinal detachment compared with non-users. Data adjusted for gender, cataract surgery, myopia, diabetes, number of prescription drugs used and number of ophthalmic visits showed a 4.5-times greater risk.

Patients using fluoroquinolone in the year before diagnosis had a 1.55-times greater risk of developing retinal detachment compared with non-users. Adjusted data showed a 1.39-times greater risk.

The results had statistical power for fluoroquinolones as a drug class but not for specific types of fluoroquinolones, Maberley said.

Data showed no association between retinal detachment and use of oral β-lactam antibiotics and short-acting β-agonists, he said.

  • Disclosure: Maberley is a consultant for Genentech, Regeneron, Eyetech and QLT Therapeutics.

Perspective

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Steve Charles, MD, FACS, FICS
Steve Charles, MD, FACS, FICS

In my view, these carefully executed data mining research data have no influence on vitreoretinal practice; systemic fluoroquinolones are not prescribed by ophthalmologists and therefore patient warnings are not relevant. The event rate is low but statistically significant; medical professionals in other specialties must weigh the risks before prescribing and warn the patients accordingly. It is inexplicable that the risk is only for very recent use rather than long-term use. The theoretical pathogenesis arguments are circumstantial at best. The largest impact may unfortunately be causing litigation against pharmaceutical companies. Another unintended consequence of this study is that patients may be given alternative, less effective antibiotics.

Steve Charles, MD, FACS, FICS
Charles Retina Institute,
Memphis, Tenn.
Disclosures: Charles has no relevant financial disclosures.