Using Real-World Data to Assess the Association of Retinal Detachment With Topical Pilocarpine Use

Abdelrahman M Elhusseiny; Muhammad Z Chauhan; Sayena Jabbehdari; Nayef Alshammari; Sarah Jong; Paul H Phillips; Ahmed B Sallam

doi:10.1016/j.ajo.2024.10.035

Using Real-World Data to Assess the Association of Retinal Detachment With Topical Pilocarpine Use

Am J Ophthalmol. 2024 Nov 6:271:1-6. doi: 10.1016/j.ajo.2024.10.035. Online ahead of print.

Authors

Abdelrahman M Elhusseiny¹, Muhammad Z Chauhan², Sayena Jabbehdari², Nayef Alshammari², Sarah Jong², Paul H Phillips², Ahmed B Sallam³

Affiliations

¹ From the Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences (A.M.E., M.Z.C., S.J., N.A., S.J., P.H.P., A.B.S.), Little Rock, Arkansas, USA; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School (A.M.E.), Boston, Massachusetts, USA.
² From the Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences (A.M.E., M.Z.C., S.J., N.A., S.J., P.H.P., A.B.S.), Little Rock, Arkansas, USA.
³ From the Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences (A.M.E., M.Z.C., S.J., N.A., S.J., P.H.P., A.B.S.), Little Rock, Arkansas, USA; Department of Ophthalmology, Ain Shams University Hospitals (A.B.S.), Cairo, Egypt. Electronic address: ahmedsallam11@yahoo.com.

PMID: 39510368
DOI: 10.1016/j.ajo.2024.10.035

Abstract

Purpose: 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 = .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 = .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 = .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 < .001) compared to controls after adjusting for demographics and comorbidities. Additional risk factors for RRD included male sex (aHR: 2.36, P = .001), myopia (aHR: 2.36, P = .001), vitreous degeneration (aHR: 2.22, P = .020), lattice degeneration (aHR: 3.71, P = .010), and pseudophakia (aHR: 3.48, P < .001).

Conclusions: Our study quantified the increased risk of RRD associated with topical pilocarpine use.