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. 2025 Aug 7;25(1):447.
doi: 10.1186/s12886-025-04284-5.

Association between fluoroquinolones and retinal detachment: insights from a large German health claims-based cohort study

Julia Wicherski  1 , Jonas Peltner  1   2 , Cornelia Becker  1 , Katrin Schüssel  3 , Gabriela Brückner  3 , Andreas Schlotmann  3 , Helmut Schröder  3 , Winfried V Kern  4 , Britta Haenisch  5   6   7
Affiliations

Association between fluoroquinolones and retinal detachment: insights from a large German health claims-based cohort study

Julia Wicherski et al. BMC Ophthalmol. .

Abstract

Purpose: Real-world evidence on fluoroquinolone-associated retinal detachment is contradictory. Therefore, we aim to examine the association between newly prescribed fluoroquinolones and the occurrence of retinal detachment with recent data from a large central European country.

Methods: A cohort study with an active comparator new user design was conducted. Dispensings of fluoroquinolone episodes were compared to a group of reference antibiotic episodes (amoxicillin, amoxicillin clavulanic acid, azithromycin, cefuroxime, cephalexin, clindamycin, sulfamethoxazole-trimethoprim, and doxycycline). Data from one of the largest statutory health insurances in Germany, the AOK, were used to follow up individuals with new antibiotic dispensing during the years 2014-2018 for the occurrence of retinal detachment. Piece-wise exponential additive mixed models adjusted for person-time, age, gender, comorbidities, year, and quarter at index were applied to estimate adjusted hazard ratios (aHR) with corresponding 95% confidence intervals (95% CI).

Results: In total, 15,232,585 antibiotic episodes were included in the cohort of which 0.05% episodes had an incident retinal detachment. The covariate-adjusted hazard ratio for fluoroquinolone episodes was 1.01 [0.95;1.08]. Likewise, in the propensity score-matched cohort the covariate-adjusted hazard ratio was 0.99 [0.92;1.07]. Moreover, there was little evidence for differences in age and gender subgroups, by follow-up time, selection of active comparator agent, dosage category, or censoring approach.

Conclusions: This large German cohort study found no meaningful real-world evidence for the association between fluoroquinolones and retinal detachment compared to a group of active comparator antibiotics.

Keywords: Active comparator new user design; Administrative cohort; Adverse drug reactions; Fluoroquinolones; Real-world data.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. All authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Human ethics and consent to participate declarations: Not applicable. Data access was legally approved by the Scientific Research Institute of the AOK (WIdO). The study is based on anonymised administrative claims data that never involved patients directly. Individual patients cannot be identified and the analyses presented do not affect patients whose anonymized records were used. No ethical approval or consent to participate needed.

Figures

Fig. 1
Fig. 1
Study design diagram (template by Schneeweiss et al. [13])
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