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A recent case-control study from Canada showed a 4.5-fold increase in relative risk for retinal detachment in ophthalmology patients who were taking fluoroquinolones (NEJM JW Infect Dis Apr 11 2012). To explore this association in a general population, investigators in Denmark used data from national registries to identify nearly 750,000 episodes of oral fluoroquinolone use and 5.5 million control episodes of nonuse between 1997 and 2011 in adults. Nearly 90% of fluoroquinolone-use episodes involved ciprofloxacin.
A total of 566 incident cases of retinal detachment were identified — 72 in fluoroquinolone users and 494 in nonusers. Propensity-score analyses, adjusted for 21 factors (e.g., age, sex, eye disease, chronic disease, oral corticosteroid use), revealed no significant differences in risk for retinal detachment with current or past use of fluoroquinolones compared with nonuse.
Pasternak B et al. Association between oral fluoroquinolone use and retinal detachment. JAMA 2013 Nov 27; 310:2184. (http://dx.doi.org/10.1001/jama.2013.280500)
Comment
In the previously published Canadian study, which was restricted to ophthalmology patients, the very high incidence of retinal detachment coupled with less rigorous adjustment for potential confounding factors might have skewed results in favor of excess risk with fluoroquinolone use. We have reasons to be concerned about excessive fluoroquinolone use (e.g., tendon rupture, microbial resistance), but retinal detachment probably isn't one of the things that should alarm patients.