Fluoroquinolones are commonly prescribed classes of antibiotics, yet despite numerous case reports of ocular toxicity, a pharmacoepidemiological study of their ocular safety, particularly retinal detachment, has not been performed. Investigators in the following study examined the association between the use of oral fluoroquinolones and the risk of developing a retinal detachment.

This was a nested case-control study of a cohort of patients in British Columbia, Canada, who had visited an ophthalmologist between January 2000 and December 2007. The study investigators defined retinal detachment cases as a procedure code for retinal repair surgery within 14 days of a physician service code. They selected 10 controls for each case using risk-set sampling, matching on age and the month and year of cohort entry. The association between retinal detachment and current, recent or past use of an oral fluoroquinolone served as the main outcome measure.

From a cohort of 989,591 patients, the investigators identified 4,384 cases of retinal detachment and 43,840 controls. They associated current use of fluoroquinolones with a higher risk of developing a retinal detachment (3.3% of cases vs 0.6% of controls; adjusted rate ratio [ARR], 4.50 [95% CI, 3.56–5.70]). Neither recent use (0.3% of cases vs 0.2% of controls; ARR, 0.92 [95% CI, 0.45–1.87]) nor past use (6.6% of cases vs 6.1% of controls; ARR, 1.03 [95% CI, 0.89–1.19]) was associated with a retinal detachment. The absolute increase in the risk of a retinal detachment was 4 per 10 000 person-years (number needed to harm = 2500 computed for any use of fluoroquinolones). There was no evidence of an association between development of a retinal detachment and Β-lactam antibiotics (ARR, 0.74 [95% CI, 0.35–1.57]) or short-acting Β-agonists (ARR, 0.95 [95% CI, 0.68–1.33]).

To conclude, patients taking oral fluoroquinolones were at a higher risk of developing a retinal detachment compared with nonusers, although the absolute risk for this condition was small.

To examine possible differences in the clinical outcomes of topical anesthesia (TA) and regional anesthesia including retrobulbar anesthesia (RBA) and peribulbar anesthesia (PBA) in phacoemulsification, a systematic review and meta-analysis was conducted involving patients from previously published randomized controlled trials (RCTs) of phacoemulsification under TA and RBA/PBA reporting clinical outcomes.

Additionally, a comprehensive literature search was performed according to the Cochrane Collaboration method to identify RCTs that compare TA and RBA/PBA in phacoemulsification. Primary outcome parameters investigated were pain score during and after surgery, intraoperative difficulties and inadvertent ocular movement, intraoperative necessity to administer additional anesthesia, and patient preference. Secondary outcome parameters investigated were postoperative visual acuity, anesthesia-related complications, intraoperative complications, and severe local or systemic complications.

A total of 15 studies were identified and analyzed to compare TA (1,084 eyes) with RBA/PBA (1,121 eyes) in phacoemulsification and data synthesis showed that intraoperative and postoperative pain perception was significantly higher in the TA group (p<0.05). The TA group showed more frequent inadvertent ocular movement (p< 0.05) and a greater intraoperative need for supplementary anesthesia (p = 0.03). There was no statistically significant difference between the 2 groups in intraoperative difficulties as assessed by the surgeons (p>0.05). Patients significantly preferred TA (p<0.00001). The RBA/PBA group had more frequent anesthesia-related complications, such as chemosis, periorbital hematoma, and subconjunctival hemorrhage (p<0.05). There was no statistically significant difference in surgery-related complications (p>0.05).

Compared with RBA/PBA, TA does not provide the same excellent pain relief in cataract surgery; however, it achieves similar surgical outcomes. Topical anesthesia reduces injection-related complications and alleviates patients' fear of injection. The choice of TA is not suitable for patients with a higher initial blood pressure or greater pain perception.

In the following prospective study, the authors sought to determine the associations between medical, demographic, socioeconomic and ocular factors and adherence to topical glaucoma ocular hypotensive therapy.

They included 116 patients with ocular hypertension or open-angle glaucoma from two tertiary glaucoma services and measured adherence to ocular hypotensive therapy using an electronic dose monitor (Travatan Dosing Aid, Alcon Laboratories Inc.) and collected data at 3 months after enrollment. The authors used three different definitions of adherence: Definition 1: the proportion of days taking the prescribed number of drops within 3 hours of the prescribed dosing time; Definition 2: the proportion of days taking any drops within 3 hours of the prescribed dosing time; and Definition 3: the proportion of days taking any drops within 6 hours of the prescribed dosing time. They used univariate and multivariate models to determine the association between the three adherence definitions, medical, demographic, socioeconomic and ocular factors at 3-month follow-up. The main outcome measures for this study were risk factors for poor objective medication adherence.

Adherence, using Definition 1, Definition 2, and Definition 3, was 64%, 75%, and 80%, respectively, the study authors reported. They also noted that age, total number of other eye diseases and race were significantly associated with full treatment adherence (Definition 1), with race alone significantly predicting 11% of full treatment adherence. For Definition 2, age, income, level of education, and total number of eye diseases were significantly associated with partial adherence (3 h), again race alone significantly predicted 15% of partial adherence (any drops within 3 h). For Definition 3, race, income, level of education, and total number of other eye diseases significantly predicted partial adherence (any drops within 6 h), both race and income predicted 19% of partial treatment adherence. Moreover, they found significant differences for adherence rates between patients of European descent and those of African descent for all 3 definitions with those who were less adherent more likely to be of African descent.

In conclusion, electronic dose monitors provide important information regarding adherence to topical ocular hypotensive medications in glaucoma patients. They show low adherence in a significant number of participants. Future studies are needed to determine the reasons for these differences in health behaviors related to glaucoma treatment, which should guide treatment of poor adherence with glaucoma therapy.

There have been several published reports of inflammatory ocular adverse events, mainly uveitis and scleritis, among patients taking oral bisphosphonates. Researchers from Vancouver, BC, examined the risk of these adverse events in a pharmacoepidemiologic cohort study.

They conducted a retrospective cohort study involving residents of British Columbia who had visited an ophthalmologist from 2000 to 2007. Within the cohort, they identified all people who were first-time users of oral bisphosphonates and who were followed to the first inflammatory ocular adverse event, death, termination of insurance or the end of the study period. Additionally, they defined an inflammatory ocular adverse event as scleritis or uveitis and used a Cox proportional hazard model to determine the adjusted rate ratios. As a sensitivity analysis, they performed a propensity–score–adjusted analysis.

The cohort comprised 934,147 people, including 10,827 first-time users of bisphosphonates and 923,320 nonusers. According to the researchers, the incidence rate among first-time users was 29/10 000 person-years for uveitis and 63/10 000 person-years for scleritis. In contrast, the incidence among people who did not use oral bisphosphonates was 20/10 000 person-years for uveitis and 36/10 000 for scleritis (number needed to harm: 1100 and 370, respectively). First-time users had an elevated risk of uveitis (adjusted relative risk [RR] 1.45, 95% confidence interval [CI] 1.25–1.68) and scleritis (adjusted RR 1.51, 95% CI 1.34–1.68). Furthermore, the rate ratio for the propensity–score–adjusted analysis did not change the results (uveitis: RR 1.50, 95% CI 1.29–1.73; scleritis: RR 1.53, 95% CI 1.39–1.70).

The study researchers concluded that people using oral bisphosphonates for the first time may be at a higher risk of scleritis and uveitis compared to people with no bisphosphonate use. Patients taking bisphosphonates must be familiar with the signs and symptoms of these conditions, so that they can immediately seek assessment by an ophthalmologist.