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Original Investigation
October 2018

Association of Corticosteroid Use With Incidence of Central Serous Chorioretinopathy in South Korea

Author Affiliations
  • 1Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-do, Korea
JAMA Ophthalmol. 2018;136(10):1164-1169. doi:10.1001/jamaophthalmol.2018.3293
Key Points

Question  What is the incidence of central serous chorioretinopathy (CSC) among patients who have ever used corticosteroid and those who have never used it, based on a national sample cohort in South Korea?

Findings  In this population-based cohort study, 5-year incidence of CSC per 10 000 person-years was 3.5 in the general population, 2.5 among those who had never used corticosteroids, and 3.6 among those who had ever used corticosteroids. The incidence was higher in men and those aged 40 to 49 years.

Meaning  These findings provide additional evidence that corticosteroid use increases the risk of CSC; however, the risk ratio in this study was less than that previously reported.

Abstract

Importance  Information on the incidence of central serous chorioretinopathy (CSC) in individuals who receive corticosteroids is scarce but clinically important because these agents are useful and widely used.

Objective  To estimate the annual and 5-year incidence of CSC in South Korea in the overall population and in those who have used corticosteroid medications.

Design, Setting, and Participants  A cohort study of a population-based random sample included East Asian adults for whom records are held in the Korean National Health Insurance Service database for calendar years 2011 through 2015. The data analysis was performed from July 1, 2017 to January 5, 2018.

Exposures  Any type of corticosteroid use from 2002 through 2015.

Main Outcomes and Measures  Incidence of CSC.

Results  The data set contained data from 868 939 adults (4 117 768 person-years). From 2011 through 2015, 1423 individuals (among whom the mean [SD] age was 46.8 [16.4] years and 1091 [76.7%] were male) with newly diagnosed CSC were identified. From 2002 to 2015, 783 099 individuals in the data set (90.1%) had ever used corticosteroids. The incidence of CSC per 10 000 person-years was 3.5 (5.4 in men; 1.6 in women) among the total population, 2.5 (3.0 in men; 1.2 in women) in those who had never used corticosteroids, and 3.6 (5.7 in men; 1.6 in women) among those who had ever used corticosteroids. The risk of CSCR with individuals who had ever used corticosteroids was estimated as an adjusted hazard ratio of 1.81 (95% CI, 1.47-2.23) compared with those who have never used these drugs. Current or recent corticosteroid use showed a positive association with the incidence of CSC (depending on duration of use, adjusted hazard ratio ranged from 1.54 to 2.15). Corticosteroid use in 2006 through 2009 was associated with an increased incidence of CSC after 2011 (adjusted hazard ratio 1.57 [95% CI, 1.13-2.18]).

Conclusions and Relevance  In 2002 through 2015, 90.1% of adults in Korea received corticosteroids at least once. Although there was a clear difference in relative risk, this data analysis could not replicate the more than 30-fold increase in the risk ratio of CSC that has been reported previously. The incidence of CSC in the most vulnerable group, middle-aged men, was estimated to be approximately 1 case per 1000 corticosteroid users in the year following medication use. The overall incidence among those who had ever used corticosteroids and those who had never used these drugs was 2.5 and 3.6 per 10 000 person-years, respectively. This study provides additional evidence to support the potential role of corticosteroids in CSC.

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