Oral Fluoroquinolones and Risk of Glaucoma
Objective: To evaluate the risk of developing glaucoma in patients taking systemic fluoroquinolones.
Methods: A case-control study was carried out among a cohort of subjects who had visited an ophthalmologist in the Province of British Columbia, Canada from 2000 to 2007. Cases were identified as those newly diagnosed with glaucoma (ICD-9 360). For each case, 5 controls were selected and matched to the cases by age and calendar time. Crude and adjusted rate ratios (RRs) for current, recent, past, and distant use of fluoroquinolones were calculated.
Results: From the cohort of 989,591 subjects, 178,264 subjects were diagnosed with glaucoma and 891,320 were corresponding controls. The 2 groups had same average age of 65 and comparable systemic comorbidities including hypertension, coronary artery disease, and diabetes. There was no statistically significant association between the use of systemic fluoroquinolones and the development of glaucoma for current use [RR=1.01 (95% confidence interval (CI), 0.95–1.07)], recent use [RR=1.00 (95% CI, 0.92–1.08)], or past use [RR=0.94 (95% CI, 0.90–1.00)]. Distant use of systemic fluoroquinolones had a small statistically significant increased risk of developing glaucoma [RR=1.12 (95% CI, 1.09–1.14)].
Conclusions: There was no detected increased association of the development of glaucoma with current, recent, or past use of systemic fluoroquinolone but a minimal statistically significant increased risk was associated with distant use. Future studies should further examine a potential delayed response with fluoroquinolones and glaucoma.
Fluoroquinolones are a class of synthetic broad spectrum antibiotics used to treat various systemic infections such as chronic bronchitis, pneumonia, sinusitis, and genitourinary infections. Common systemic side effects such as QTc interval prolongation, seizures, phototoxicity, and tendinopathy have been well established. However, ocular involvement such as uveitis from systemic administration was not reported until 2004. Since then, multiple ocular side effects such as optic neuropathy, retinal hemorrhage, diplopia, and retinal detachment have been reported. Hinkle et al have reported a possible association between uveitis and fluoroquinolone therapy, especially with iris transillumination defect and pigment dispersion. Bettink-Remeijer et al have also reported a uveitis-like syndrome secondary to systemic fluoroquinolone. Specifically, 2 clinical entities, bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT) were described with association with oral moxifloxacin; 28.5% of patient with BADI and 35% of patients with BAIT had exposure to systemic moxifloxacin. In addition, 31% of patients with BAIT and 19% of patients with BADI had elevated intraocular pressure (IOP) over 21 mm Hg. This is a case-control study to evaluate a possible association between the development of glaucoma and systemic fluoroquinolone use.
Abstract and Introduction
Abstract
Objective: To evaluate the risk of developing glaucoma in patients taking systemic fluoroquinolones.
Methods: A case-control study was carried out among a cohort of subjects who had visited an ophthalmologist in the Province of British Columbia, Canada from 2000 to 2007. Cases were identified as those newly diagnosed with glaucoma (ICD-9 360). For each case, 5 controls were selected and matched to the cases by age and calendar time. Crude and adjusted rate ratios (RRs) for current, recent, past, and distant use of fluoroquinolones were calculated.
Results: From the cohort of 989,591 subjects, 178,264 subjects were diagnosed with glaucoma and 891,320 were corresponding controls. The 2 groups had same average age of 65 and comparable systemic comorbidities including hypertension, coronary artery disease, and diabetes. There was no statistically significant association between the use of systemic fluoroquinolones and the development of glaucoma for current use [RR=1.01 (95% confidence interval (CI), 0.95–1.07)], recent use [RR=1.00 (95% CI, 0.92–1.08)], or past use [RR=0.94 (95% CI, 0.90–1.00)]. Distant use of systemic fluoroquinolones had a small statistically significant increased risk of developing glaucoma [RR=1.12 (95% CI, 1.09–1.14)].
Conclusions: There was no detected increased association of the development of glaucoma with current, recent, or past use of systemic fluoroquinolone but a minimal statistically significant increased risk was associated with distant use. Future studies should further examine a potential delayed response with fluoroquinolones and glaucoma.
Introduction
Fluoroquinolones are a class of synthetic broad spectrum antibiotics used to treat various systemic infections such as chronic bronchitis, pneumonia, sinusitis, and genitourinary infections. Common systemic side effects such as QTc interval prolongation, seizures, phototoxicity, and tendinopathy have been well established. However, ocular involvement such as uveitis from systemic administration was not reported until 2004. Since then, multiple ocular side effects such as optic neuropathy, retinal hemorrhage, diplopia, and retinal detachment have been reported. Hinkle et al have reported a possible association between uveitis and fluoroquinolone therapy, especially with iris transillumination defect and pigment dispersion. Bettink-Remeijer et al have also reported a uveitis-like syndrome secondary to systemic fluoroquinolone. Specifically, 2 clinical entities, bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT) were described with association with oral moxifloxacin; 28.5% of patient with BADI and 35% of patients with BAIT had exposure to systemic moxifloxacin. In addition, 31% of patients with BAIT and 19% of patients with BADI had elevated intraocular pressure (IOP) over 21 mm Hg. This is a case-control study to evaluate a possible association between the development of glaucoma and systemic fluoroquinolone use.