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Original Investigation |

Association Between Oral Fluoroquinolone Use and Retinal Detachment

Fanny Raguideau, PharmD1; Magali Lemaitre, PhD1; Rosemary Dray-Spira, MD, PhD1; Mahmoud Zureik, MD, PhD1
[+] Author Affiliations
1Department of Epidemiology of Health Products, The French National Agency for Medicines and Health Products Safety, Saint-Denis, France
JAMA Ophthalmol. 2016;134(4):415-421. doi:10.1001/jamaophthalmol.2015.6205.
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Importance  Several studies have focused on the current use of oral fluoroquinolones and the risk for retinal detachment (RD), but the existence of this association is under debate. Given the widespread fluoroquinolone use, investigation of this association is essential.

Objective  To assess the association between oral fluoroquinolone use and the risk for RD, including the rhegmatogenous and exudative types.

Design, Setting, and Participants  This case-crossover study included 27 540 adults with RD from French health care databases from July 1, 2010, through December 31, 2013. Patients with a history of RD or retinal break, endophthalmitis, intravitreal injection, choroidal retinal vitreal biopsy, and human immunodeficiency virus infection or those hospitalized within 6 months of RD were excluded. The risk period of primary interest was current use, defined as exposure to fluoroquinolones within 10 days immediately before RD surgery, according to previous findings. Oral fluoroquinolone use was assumed to start on the day the prescription was dispensed.

Main Outcomes and Measures  Exposure to fluoroquinolones during the risk period (1-10 days) compared with the control period (61-180 days). The association was also assessed regarding use in the recent (11-30 days) and past (31-60 days) intermediate risk period, type of fluoroquinolone, and type of RD.

Results  Of the 27 540 eligible patients (57% men; mean [SD] age, 61.5 [13.6] years), 663 patients with RD were exposed to fluoroquinolones during the observation period, corresponding to 80 cases exposed during the 10-day risk period (≤10 days before RD) and 583 cases exposed during the control period (61-180 days). We found a significant increased risk for RD during the 10-day period after the dispensing of oral fluoroquinolones, with an adjusted odds ratio of 1.46 (95% CI, 1.15-1.87). The risk was significantly increased for rhegmatogenous and exudative RD, with adjusted odds ratios of 1.41 (95% CI, 1.04-1.92) and 2.57 (95% CI, 1.46-4.53), respectively. Recent and past use of fluoroquinolones were not associated with a higher risk for RD, with adjusted odds ratios of 0.94 (95% CI, 0.78-1.14) and 1.06 (95% CI, 0.91-1.24), respectively.

Conclusions and Relevance  Current oral fluoroquinolone use was associated with an increased risk for RD, including the rhegmatogenous and exudative types. These findings, along with the available literature, suggest an association between fluoroquinolone use and the risk for RD. The nature of this association should be further investigated in future studies.

Figures in this Article

Figures

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Figure 1.
Diagram of the Case-Crossover Design

Solid bars indicate exposure to fluoroquinolones. RD indicates retinal detachment.

aRandom control periods of 10 days.

bRandom control periods of 30 days.

Graphic Jump Location
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Figure 2.
Study Flowchart

RD indicates retinal detachment.

Graphic Jump Location

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