Oral Fluoroquinolones and the Risk of Retinal Detachment

Context Fluoroquinolones are commonly prescribed classes of antibiotics. Despite numerous case reports of ocular toxicity, a pharmacoepidemiological study of their ocular safety, particularly retinal detachment, has not been performed. Objective To examine the association between use of oral fluoroquinolones and the risk of developing a retinal detachment. Design, Setting, and Patients Nested case-control study of a cohort of patients in British Columbia, Canada, who had visited an ophthalmologist between January 2000 and December 2007. Retinal detachment cases were defined as a procedure code for retinal repair surgery within 14 days of a physician service code. Ten controls were selected for each case using risk-set sampling, matching on age and the month and year of cohort entry. Main Outcome Measure The association between retinal detachment and current, recent, or past use of an oral fluoroquinolone. Results From a cohort of 989 591 patients, 4384 cases of retinal detachment and 43 840 controls were identified. Current use of fluoroquinolones was associated with a higher risk of developing a retinal detachment (3.3% of cases vs 0.6% of controls; adjusted rate ratio [ARR], 4.50 [95% CI, 3.56-5.70]). Neither recent use (0.3% of cases vs 0.2% of controls; ARR, 0.92 [95% CI, 0.45-1.87]) nor past use (6.6% of cases vs 6.1% of controls; ARR, 1.03 [95% CI, 0.89-1.19]) was associated with a retinal detachment. The absolute increase in the risk of a retinal detachment was 4 per 10 000 person-years (number needed to harm=2500 computed for any use of fluoroquinolones). There was no evidence of an association between development of a retinal detachment and beta-lactam antibiotics (ARR, 0.74 [95% CI, 0.35-1.57]) or short-acting beta-agonists (ARR, 0.95 [95% CI, 0.68-1.33]). Conclusion Patients taking oral fluoroquinolones were at a higher risk of developing a retinal detachment compared with nonusers, although the absolute risk for this condition was small. JAMA. 2012;307(13):1414-1419