Exposure to Oral Fluoroquinolones and the Risk of Retinal Detachment: Retrospective Analyses of Two Large Healthcare Databases

Fife, Daniel; Zhu, Vivienne; Voss, Erica; Levy-Clarke, Grace; Ryan, Patrick
March 2014
Drug Safety;Mar2014, Vol. 37 Issue 3, p171
Academic Journal
Background: A recent Canadian case-control study reported a 4.5-fold increased risk of retinal detachment (RD) during oral fluoroquinolone use. Of the fluoroquinolone-exposed cases, 83 % were exposed to ciprofloxacin. We sought to replicate this finding, and assess whether it applied to all fluoroquinolones. Methods: In two large US healthcare databases, we performed three case-control analyses: one replicating the recent study; one addressing additional potential confounders; and one that increased sample size by dropping the Canadian study's requirement for a prior ophthalmologist visit. We also performed a self-controlled case-series (SCCS) analysis in which each subject served as his or her own comparator. Results: In the replication case-control analyses, the adjusted odds ratios (ORs) for any exposure to fluoroquinolones or ciprofloxacin were approximately 1.2 in both databases, and were statistically significant, and the ORs for current exposure were modestly above 1 in one database, modestly below 1 in the other, and not statistically significant. In the other case-control analyses, the ORs were close to 1. In a post hoc age-stratified case-control analysis, we observed an association of RD with fluoroquinolone exposure among older subjects in one of the two databases. All estimates from the SCCS analyses were below 1.2 and none was statistically significant. Conclusion: The present study does not confirm the recent Canadian study's finding of a strong relationship between RD and current exposure to fluoroquinolones. Instead, it found a modest association between RD and current or any exposure to fluoroquinolones in the case-control analyses, and no association in the SCCS analyses.


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