May 01, 2014
Fluoroquinolones are one of the most commonly prescribed classes of antibiotics. Routinely used for a wide range of clinical indications, they account for more than 32 million U.S. outpatient prescriptions annually.
Fluoroquinolones can produce severe systemic adverse effects, including tendinopathy and cardiac arrhythmias. Reported ocular adverse effects include uveitis, iris transillumination, pigment dispersion, optic neuropathy, diplopia, retinal hemorrhage, serous macular detachment and, more recently, retinal detachment as reported in the Journal of the American Medical Association in 2012.
Andrew J. Barkmeier, M.D., with the Department of Ophthalmology at Mayo Clinic in Rochester, Minn., leads a team that further investigated the potential relationship between these common medications and retinal detachment to determine whether oral fluoroquinolone medications increase the risk of rhegmatogenous retinal detachment and acute symptomatic retinal breaks. "Given the widespread use of fluoroquinolones and the sight-threatening nature of rhegmatogenous retinal detachment, such an association would have significant clinical implications," says Dr. Barkmeier.
Using records from the Rochester Epidemiology Project (REP) database for a retrospective review, the team identified 38,046 unique patients age 18 or older who were prescribed oral fluoroquinolones in Olmsted County, Minn., between Jan. 1, 2003, and June 30, 2011, as well as all retinal detachment repair and prophylaxis procedures performed within one year of the prescription dates. The team compared these procedure rates with rates identified in cohorts of patients prescribed macrolide and beta-lactam antibiotics during the same time frame. Retinal detachment repair rates were also compared with Olmsted County population-based historical controls from a previous REP study (1976 through 1995).
"A review of charts revealed which patients had truly developed spontaneous rhegmatogenous retinal detachment, as opposed to those who underwent surgical procedures for diabetic tractional retinal detachment, or for retinal detachment associated with trauma or endophthalmitis. We were also able to identify which retinal detachment prophylaxis procedures were performed for acutely symptomatic retinal tears, while excluding treatments for other lesions or for tears of unknown chronicity," says Dr. Barkmeier.
No increased risk identified
Results showed that no rhegmatogenous retinal detachments occurred during the initial fluoroquinolone treatment course for any of the 38,046 study patients. There were no differences in the rate of rhegmatogenous retinal detachment repair or symptomatic retinal break prophylaxis within 7, 30, 90 or 365 days of initial prescription dates for oral fluoroquinolone, macrolide or beta-lactam antibiotics (p > 0.05 for all comparisons):
- Retinal detachment repair procedures were performed within 365 days in 0.03 percent of the fluoroquinolone, 0.02 percent of the macrolide and 0.03 percent of the beta-lactam cohorts.
- Retinal detachment prophylaxis procedures were performed within 365 days in 0.01 percent of the fluoroquinolone, 0.02 percent of the macrolide and 0.02 percent of the beta-lactam cohorts.
There was no difference in the age- and sex-adjusted incidence of rhegmatogenous retinal detachment following a patient's initial fluoroquinolone prescription when compared with the expected rate from Olmsted County, Minn., historical controls (36.8 per 100,000/year vs. 28.8 per 100,000/year, p = 0.35). Furthermore, no fluoroquinolone dosage effect was identified for retinal detachment rates following larger initial medication exposure or multiple prescriptions during the study period.
"Our ultimate objective is to more accurately counsel patients and other providers on potential retinal risks associated with oral fluoroquinolone medications," says Dr. Barkmeier. "We did not identify any increased risk of retinal detachment or acute retinal tears after oral fluoroquinolone prescriptions."
Dr. Barkmeier presented this research at the annual meeting of the American Academy of Ophthalmology in 2013. The study was published in Ophthalmology online in January 2014.
For more information
Etminan M, et al. Oral fluoroquinolones and the risk of retinal detachment. Journal of the American Medical Association. 2012;307:1414.
Barkmeier AJ, et al. Oral fluoroquinolones and the incidence of rhegmatogenous retinal detachment and symptomatic retinal breaks: A population-based study. Presentation at: American Academy of Ophthalmology annual meeting; 2013; New Orleans.
Kapoor KG, et al. Oral fluoroquinolones and the incidence of rhegmatogenous retinal detachment and symptomatic retinal breaks: A population-based study. Ophthalmology. In press.