Systemic Statin Use and Reduced Risk of Repeat Retinal Detachment Repair: A Retrospective Cohort Study

Recurrent retinal detachment (RD) is a major determinant of vision loss after primary repair, largely driven by proliferative vitreoretinopathy, a fibroinflammatory wound-healing process implicating hypoxia-inducible factor (HIF). Statins possess anti-inflammatory and antifibrotic properties and indirectly inhibit HIF. We evaluated whether preoperative statins reduced the 1-year risk of repeat RD repair after primary repair.

Single health system propensity-matched retrospective cohort study.

Using the Patient Data Science Repository, we identified patients aged ≥30 years who underwent primary RD repair between 2005 and 2025. A 1:1 propensity score-matched control group was generated based on demographics, smoking, hypertension, diabetes, obesity, myopia, uveitis, cataract surgery, and open globe injury.

Statin exposure was defined as >90 cumulative use-days in the year before primary RD repair.

Repeat RD repair within 1 year of primary RD surgery was evaluated using Cox proportional hazards models to estimate hazard ratios (HRs). Sensitivity analyses included a negative control (proton pump inhibitors [PPIs] vs. unexposed), active comparator (statins vs. PPIs), and analyses by statin subclass and individual agents.

We identified 1232 statin-exposed patients and 1232 matched controls. At 1 year, repeat RD repair occurred in 16.1% of statin users versus 21.1% of controls (HR = 0.75; 95% confidence interval [CI], 0.62-0.89; P = 0.0014), with an absolute risk difference of 5.0%. The negative control showed no difference (17.2% vs. 18.0%; HR = 0.95; 95% CI, 0.74-1.22; P = 0.685). In the active-comparator analysis (PPI; n = 370 vs. statin n = 681), recurrent RD occurred in 14.5% of statin users versus 19.7% of PPI users (HR = 0.71; 95% CI, 0.54-0.95; P = 0.0224). After Bonferroni correction, only simvastatin (simvastatin n = 42/284 [14.8%] vs. control n = 67/284 [23.6%]) among statin subclasses and individual agent comparisons was significantly associated with a reduced risk of repeat RD repair (HR = 0.59; 95% CI, 0.41-0.86; P = 0.0059, Bonferroni-adjusted P = 0.0356).

Statin use was associated with a lower risk of repeat RD repair, with the clearest signal for simvastatin. Prospective studies are needed to confirm causality and explore delivery approaches to reduce recurrence risk.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.