In the Journals

Risk for retinal detachment not increased with fluoroquinolones

Oral fluoroquinolone use did not lead to higher risk for retinal detachment, researchers from Statens Serum Institut in Copenhagen, Denmark, have found.

“Given the limited power, this study can only rule out more than a threefold relative increase in the risk of retinal detachment associated with current fluoroquinolone use,” the researchers wrote in JAMA. “However, any differences in absolute risk are likely to have limited, if any, clinical significance.”

The researchers used data from registries in Denmark to link participant characteristics, filled prescriptions and cases of retinal detachment and surgical treatment from 1997 to 2011. The cohort included 748,792 episodes of fluoroquinolone use and 5,520,446 control episodes of nonuse. The most common fluoroquinolone used was ciprofloxacin.

In the entire cohort, there were 566 cases of retinal detachment, for an incidence rate of 19.5 per 100,000 person-years. Seventy-two cases were among people exposed to fluoroquinolones and 494 were among the nonuser controls. Current fluoroquinolone use was not associated with an increased risk for retinal detachment (RR=1.29; 95% CI, 0.53-3.13). There also was no increased risk for retinal detachment associated with recent, past or distant use of fluoroquinolones.

“Our study was prompted by the findings of a recent nested case-control study [in Canada that] reported that retinal detachment was strongly associated with oral fluoroquinolone use,” the researchers wrote. “While the Canadian study was restricted to ophthalmologic patients, our cohort was derived from the entire adult population of Denmark. The Canadian study was therefore enriched with patients who were at higher risk of retinal detachment.”

In an accompanying editorial, Allan S. Brett, MD, of the University of South Carolina School of Medicine, said physicians must make judgments about patients’ need to know about potential, rare adverse effects that were demonstrated in observational studies, and use the data when necessary.

“For the physician caring for an inpatient with an indication for fluoroquinolone therapy, retinal detachment should not cross the physician’s mind,” he wrote. “But the next time an outpatient with no good indication for a quinolone asks for one ‘because I got better last time I took it,' the physician might mention a remote possibility of retinal detachment among the many reasons for declining the request.”

For more information:

Brett A. JAMA. 2013;310:2151-2152.

Pasternak B. JAMA. 2013;310:2184-2190.

Disclosure: The researchers report no relevant financial disclosures.

Oral fluoroquinolone use did not lead to higher risk for retinal detachment, researchers from Statens Serum Institut in Copenhagen, Denmark, have found.

“Given the limited power, this study can only rule out more than a threefold relative increase in the risk of retinal detachment associated with current fluoroquinolone use,” the researchers wrote in JAMA. “However, any differences in absolute risk are likely to have limited, if any, clinical significance.”

The researchers used data from registries in Denmark to link participant characteristics, filled prescriptions and cases of retinal detachment and surgical treatment from 1997 to 2011. The cohort included 748,792 episodes of fluoroquinolone use and 5,520,446 control episodes of nonuse. The most common fluoroquinolone used was ciprofloxacin.

In the entire cohort, there were 566 cases of retinal detachment, for an incidence rate of 19.5 per 100,000 person-years. Seventy-two cases were among people exposed to fluoroquinolones and 494 were among the nonuser controls. Current fluoroquinolone use was not associated with an increased risk for retinal detachment (RR=1.29; 95% CI, 0.53-3.13). There also was no increased risk for retinal detachment associated with recent, past or distant use of fluoroquinolones.

“Our study was prompted by the findings of a recent nested case-control study [in Canada that] reported that retinal detachment was strongly associated with oral fluoroquinolone use,” the researchers wrote. “While the Canadian study was restricted to ophthalmologic patients, our cohort was derived from the entire adult population of Denmark. The Canadian study was therefore enriched with patients who were at higher risk of retinal detachment.”

In an accompanying editorial, Allan S. Brett, MD, of the University of South Carolina School of Medicine, said physicians must make judgments about patients’ need to know about potential, rare adverse effects that were demonstrated in observational studies, and use the data when necessary.

“For the physician caring for an inpatient with an indication for fluoroquinolone therapy, retinal detachment should not cross the physician’s mind,” he wrote. “But the next time an outpatient with no good indication for a quinolone asks for one ‘because I got better last time I took it,' the physician might mention a remote possibility of retinal detachment among the many reasons for declining the request.”

For more information:

Brett A. JAMA. 2013;310:2151-2152.

Pasternak B. JAMA. 2013;310:2184-2190.

Disclosure: The researchers report no relevant financial disclosures.