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Using Real-World Data to Assess the Association of Retinal Detachment With Topical Pilocarpine Use
TAKE-HOME MESSAGE
- An analysis of data from a large database showed that, although the incidence of rhegmatogenous retinal detachment (RRD) in patients with presbyopia using topical pilocarpine was low, it was significantly greater than that found in controls using artificial tears: 0.53% versus 0.25% at 3 months, 0.60% versus 0.31% at 6 months, and 0.78% versus 0.33% at 12 months. The risk of RRD associated with pilocarpine use increased in eyes with myopia, lattice degeneration, vitreous degeneration, or pseudophakia.
- Patients who wish to use pilocarpine eye drops for the treatment of presbyopia should be carefully examined for predisposing retinal conditions, both prior to the initiation of treatment and within the first 3 months, and should be educated about the risk and symptoms of RRD.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To examine the association between topical pilocarpine and the risk of new-onset rhegmatogenous retinal detachment (RRD).
DESIGN
Retrospective clinical cohort study.
METHODS
We used an aggregated electronic health records research network, TriNetX, to examine the risk of RRD (ICD-10: H33.0x) following the initiation of pilocarpine. The primary study group included adult patients over 40 years who received topical pilocarpine (1.25% or any dose with the exclusion of other indications) for the first time. Our control group consisted of patients with presbyopia who were started on artificial tears and had no history of topical pilocarpine use during the study period. We matched both cohorts using propensity score matching (PSM) based on demographics, systemic comorbidities, and known risk factors for RRD.
RESULTS
After matching, the three-month risk of RRD was significantly higher in the pilocarpine group (0.53%) compared to the control (0.25%) (RR: 2.18, 95% CI: 1.07-4.45, p=0.03). The 6-month risk of RRD remained elevated at 0.60% in the study group versus 0.31% in the control group (RR: 1.93, 95% CI: 1.01-3.67, p=0.04). At one year, the risk increased to 0.78% in the pilocarpine group and 0.33% in the control group (RR: 2.33, 95% CI: 1.28-4.27, p=0.005). A Cox proportional hazards model indicated that pilocarpine use was associated with a 3.14-fold increased risk of RRD (95% CI: 1.66-5.93, p<0.001) compared to controls, after adjusting for demographics and comorbidities. Additional risk factors for RRD included male sex (aHR: 2.36, p=0.001), myopia (aHR: 2.36, p=0.001), vitreous degeneration (aHR: 2.22, p=0.020), lattice degeneration (aHR: 3.71, p=0.010), and pseudophakia (aHR: 3.48, p<0.001).
CONCLUSIONS
Our study quantified the increased risk of RRD associated with topical pilocarpine use.
Additional Info
Using Real-World Data to Assess the Association of Retinal Detachment with Topical Pilocarpine Use
Am J Ophthalmol 2024 Nov 05;[EPub Ahead of Print], AM Elhusseiny, MZ Chauhan, S Jabbehdari, N Alshammari, S Jong, PH Phillips, AB SallamFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.