The risk of rhegmatogenous retinal detachment associated with topical pilocarpine: a systematic review.

Int OphthalmolNov 2, 2026 (epub)
Clinical ResearchOphthalmologyOpen access

Omar Badla, Molly Kennedy, Amr Almobayed et al.

✦ AI-curated · Sources linked

In 30 seconds

This systematic review assessed whether topical pilocarpine is associated with rhegmatogenous retinal detachment (RRD) in patients aged 40 years or older, synthesising 10 comparative studies. RRD was not reported in nine studies; all events came from one large retrospective cohort. In that cohort, 35 pilocarpine-exposed eyes versus 15 control eyes developed RRD, with an adjusted HR of 3.14 (95% CI 1.66-5.93, p < 0.001). The authors judged the evidence low-certainty and hypothesis-generating, noting that quantitative pooling was not feasible.

Key findings

  • Nine studies reported no RRD events among 1,876 participants.
  • In one retrospective cohort of 8,988 participants, RRD occurred in 35 pilocarpine-exposed eyes versus 15 control eyes.
  • The cohort reported an adjusted HR of 3.14 (95% CI 1.66-5.93, p < 0.001) for RRD with pilocarpine exposure.

Why it matters

The review raises a potential safety signal for RRD with topical pilocarpine, particularly among predisposed patients, but the signal rests on a single retrospective cohort. Distinguishing a possible association from a confirmed risk is important when weighing treatment and retinal risk; the event-free findings in the other studies do not resolve the uncertainty.

What to keep in mind

All reported RRD events came from one retrospective cohort; the other nine studies were event-free. Heterogeneity and sparse events prevented quantitative pooling, and the authors describe the evidence as low-certainty.

Source

PubMed · PMID 42970148Free full text on PubMed Central

Published in Int Ophthalmol. This summary was written by xxcode from the publication's abstract and metadata. It is not peer reviewed and is not a substitute for the original article. For clinical decisions, review the original publication.

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