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Oral fluoroquinolone not associated with retinal detachment
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Oral administration of fluoroquinolone was not associated with the increased risk of developing rhegmatogenous retinal detachment, but patients with exposure to the therapy for 91 to 180 days had a modest association, according to a nested case control study.
Researchers used data from the Korean National Health Insurance National Sample Cohort (KNHIS-NSC) from 2002 to 2013.
Subjects who visited an ophthalmologist were included in the cohort, and researchers defined cases as subjects who underwent surgery for rhegmatogenous retinal detachment (RRD). Controls, who did not undergo surgery for RRD, were matched by sex, age group and cohort entry data.
A total of 1,151 subjects in the case group and 11,470 subjects in the control group, were included.
“There is no proven mechanism that might explain the development of retinal detachment after fluoroquinolone,” researchers wrote.
Comorbidities associated with incidence of RRD were more frequent in the case group than in the control group for the year prior to the index date.
In the case and control groups, the percentage of subjects who underwent cataract surgery was 6.3% and 1.2%, respectively.
Researchers found a higher incidence of diabetes in the case group.
There were 146 case subjects and 1,384 control subjects with exposure to oral fluoroquinolone in the year prior to the index date. Ofloxacin was the most frequently exposed drug in the case and control groups, followed by ciprofloxacin and levofloxacin.
Researchers found a crude odds ratio of 1.06 for the risk of retinal detachment according to oral fluoroquinolone exposure in the total group population. Based on subgroups by exposure date, no subgroup showed statistical significance.
When adjusted for age group at cohort entry, sex, diabetes, household income, residential area, number of ophthalmologic visits and drug prescriptions during the year prior to the index date, and degenerative myopia, a modest significance in odds ratio was reported of 1.42.
“The lack of mechanism to explain fluoroquinolone-associated RRD might be the most important factor in the interpretation of this study and its clinical significance,” researchers wrote. – by Abigail Sutton
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Edward Chu, OD, FAAO
Retinal detachment is a serious ocular condition that frequently requires immediate intervention to prevent permanent and potentially devastating visual consequences. As eye care providers, we need to be aware of any ocular, systemic or genetic risk factors that our patients may have for developing a future retinal detachment. Having a clear and accurate picture of our patient’s overall risk allows us to formulate an appropriate management plan and properly educate them.
Recent studies have suggested the possibility of side effects such as retinal detachment stemming from oral fluoroquinolone use; however, a similar number of studies have also found no relationship between retinal detachment and this group of antibiotics.
Choi and colleagues utilized Korea’s national health care database to investigate this clinical question. Their findings suggest that oral fluoroquinolone use was not associated with an increased risk for rhegmatogenous retinal detachment. The strongest argument against this association is that there is still no proven mechanism to explain why fluoroquinolones would increase overall risk.
Until a clear association and mechanism can be established, we can feel more confident that our patients taking oral fluoroquinolones may not be need more frequent follow-ups for peripheral retina exams.
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