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

center dot PURPOSE: To examine the association between topical pilocarpine and the risk of new-onset rhegmatogenous retinal detachment (RRD). center dot DESIGN: Retrospective clinical cohort study. center dot 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. center dot 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: 1.013.67, 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 degen eration (aHR: 3.71, P = . 010), and pseudophakia (aHR: 3.48, P < . 001). center dot CONCLUSIONS: Our study quantified the increased risk of RRD associated with topical pilocarpine use. (Am J Ophthalmol 2025;271: 1-6. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)