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Association between oral fluoroquinolone use and retinal detachment.
JAMA. 2013 Nov 27; 310(20):2184-90.JAMA

Abstract

IMPORTANCE

A recent study of ophthalmologic patients found a strong association between fluoroquinolone use and retinal detachment. Given the prevalent use of fluoroquinolones, this could, if confirmed in the general population, translate to many excess cases of retinal detachment that are potentially preventable.

OBJECTIVE

To investigate if oral fluoroquinolone use is associated with an increased risk of retinal detachment.

DESIGN, SETTING, AND PARTICIPANTS

A nationwide, register-based cohort study in Denmark from 1997 through 2011, using linked data on participant characteristics, filled prescriptions, and cases of retinal detachment with surgical treatment (scleral buckling, vitrectomy, or pneumatic retinopexy). The cohort included 748,792 episodes of fluoroquinolone use (660,572 [88%] ciprofloxacin) and 5,520,446 control episodes of nonuse.

MAIN OUTCOMES AND MEASURES

Poisson regression was used to estimate rate ratios (RRs) for incident retinal detachment, adjusting for a propensity score that included a total of 21 variables. The risk windows were classified as current use (days 1-10 from start of treatment), recent use (days 11-30), past use (days 31-60), and distant use (days 61-180).

RESULTS

A total of 566 cases of retinal detachment occurred, of which 465 (82%) were rhegmatogenous detachments; 72 in fluoroquinolone users and 494 in control nonusers. The crude incidence rate was 25.3 cases per 100,000 person-years in current users, 18.9 in recent users, 26.8 in past users, and 24.8 in distant users compared with 19.0 in nonusers. Compared with nonuse, fluoroquinolone use was not associated with a significantly increased risk of retinal detachment: the adjusted RRs were 1.29 (95% CI, 0.53 to 3.13) for current use; 0.97 (95% CI, 0.46 to 2.05) for recent use; 1.37 (95% CI, 0.80 to 2.35) for past use; and 1.27 (95% CI, 0.93 to 1.75) for distant use. The absolute risk difference, estimated as the adjusted number of retinal detachment cases per 1,000,000 treatment episodes, was 1.5 (95% CI, -2.4 to 11.1) for current use.

CONCLUSIONS AND RELEVANCE

In this cohort study based on the general Danish population, oral fluoroquinolone use was not associated with increased risk of retinal detachment. Given its limited power, this study can only rule out more than a 3-fold increase in the relative risk associated with current fluoroquinolone use; however, any differences in absolute risk are likely to be of minor, if any, clinical significance.

Authors+Show Affiliations

Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24281462

Citation

Pasternak, Björn, et al. "Association Between Oral Fluoroquinolone Use and Retinal Detachment." JAMA, vol. 310, no. 20, 2013, pp. 2184-90.
Pasternak B, Svanström H, Melbye M, et al. Association between oral fluoroquinolone use and retinal detachment. JAMA. 2013;310(20):2184-90.
Pasternak, B., Svanström, H., Melbye, M., & Hviid, A. (2013). Association between oral fluoroquinolone use and retinal detachment. JAMA, 310(20), 2184-90. https://doi.org/10.1001/jama.2013.280500
Pasternak B, et al. Association Between Oral Fluoroquinolone Use and Retinal Detachment. JAMA. 2013 Nov 27;310(20):2184-90. PubMed PMID: 24281462.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between oral fluoroquinolone use and retinal detachment. AU - Pasternak,Björn, AU - Svanström,Henrik, AU - Melbye,Mads, AU - Hviid,Anders, PY - 2013/11/28/entrez PY - 2013/11/28/pubmed PY - 2013/12/16/medline SP - 2184 EP - 90 JF - JAMA JO - JAMA VL - 310 IS - 20 N2 - IMPORTANCE: A recent study of ophthalmologic patients found a strong association between fluoroquinolone use and retinal detachment. Given the prevalent use of fluoroquinolones, this could, if confirmed in the general population, translate to many excess cases of retinal detachment that are potentially preventable. OBJECTIVE: To investigate if oral fluoroquinolone use is associated with an increased risk of retinal detachment. DESIGN, SETTING, AND PARTICIPANTS: A nationwide, register-based cohort study in Denmark from 1997 through 2011, using linked data on participant characteristics, filled prescriptions, and cases of retinal detachment with surgical treatment (scleral buckling, vitrectomy, or pneumatic retinopexy). The cohort included 748,792 episodes of fluoroquinolone use (660,572 [88%] ciprofloxacin) and 5,520,446 control episodes of nonuse. MAIN OUTCOMES AND MEASURES: Poisson regression was used to estimate rate ratios (RRs) for incident retinal detachment, adjusting for a propensity score that included a total of 21 variables. The risk windows were classified as current use (days 1-10 from start of treatment), recent use (days 11-30), past use (days 31-60), and distant use (days 61-180). RESULTS: A total of 566 cases of retinal detachment occurred, of which 465 (82%) were rhegmatogenous detachments; 72 in fluoroquinolone users and 494 in control nonusers. The crude incidence rate was 25.3 cases per 100,000 person-years in current users, 18.9 in recent users, 26.8 in past users, and 24.8 in distant users compared with 19.0 in nonusers. Compared with nonuse, fluoroquinolone use was not associated with a significantly increased risk of retinal detachment: the adjusted RRs were 1.29 (95% CI, 0.53 to 3.13) for current use; 0.97 (95% CI, 0.46 to 2.05) for recent use; 1.37 (95% CI, 0.80 to 2.35) for past use; and 1.27 (95% CI, 0.93 to 1.75) for distant use. The absolute risk difference, estimated as the adjusted number of retinal detachment cases per 1,000,000 treatment episodes, was 1.5 (95% CI, -2.4 to 11.1) for current use. CONCLUSIONS AND RELEVANCE: In this cohort study based on the general Danish population, oral fluoroquinolone use was not associated with increased risk of retinal detachment. Given its limited power, this study can only rule out more than a 3-fold increase in the relative risk associated with current fluoroquinolone use; however, any differences in absolute risk are likely to be of minor, if any, clinical significance. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/24281462/Association_between_oral_fluoroquinolone_use_and_retinal_detachment_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2013.280500 DB - PRIME DP - Unbound Medicine ER -