Acute uveitis following zoledronic acid infusion

Rathnam, Krishnakumar; Sagar, Tenali Gnana; Cyriac, Sanju

doi:10.4103/0974-620x.53046

Cited by 8 publications

(6 citation statements)

References 6 publications

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“…[ 5 ] Four cases of open unilateral and bilateral anterior uveitis post zoledronic acid infusion have been reported. [ 3 6 7 8 ] It has been suggested that secretions of bisphosphonates into tears can cause conjunctivitis and other ocular inflammations. Bisphosphonates also secrete interleukins resulting in inflammatory responses in the eye.…”

Section: Discussionmentioning

confidence: 99%

Zoledronic acid induced unilateral anterior uveitis

Gupta

Onkar

Vashisht

2020

Indian J Ophthalmol

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Zoledronic acid is recommended for patients with osteoporosis. To report a case of unilateral anterior uveitis after zoledronate infusion. An osteoporotic patient presented with pain, visual loss, hyperemia, photophobia, and watering from the left eye after zoledronate infusion. Circumcorneal injection, keratic precipitates, cells, and flare suggested anterior uveitis. Her symptoms resolved completely after 20 days of prednisolone acetate with atropine eye drops. Uveitis is a rare complication of zoledronic acid with an unclear mechanism. Proinflammatory cytokines may play a role in pathogenesis. Zoledronic acid may be associated with rare but serious inflammatory ocular adverse drug reactions.

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Section: Discussionmentioning

confidence: 99%

Zoledronic acid induced unilateral anterior uveitis

Gupta

Onkar

Vashisht

2020

Indian J Ophthalmol

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“…Clinical features of 16 published cases (including our case) with ZAIU are shown in Table 1 . Eight cases suffered from osteoporosis (including our case) [ 5 – 8 , 13 , 22 , 23 ], four with bone metastasis from malignant tumors [ 9 – 11 , 24 ], one with frontal hyperostosis and breast cancer [ 25 ], one with back and femur pain from the treatment of monoclonal gammopathy of undetermined significance (MGUS) [ 14 ], and the remaining two cases had risks of osteopenia due to leuprolide treatment for prostate cancer [ 12 ]. All the ocular manifestations occurred in 3 days.…”

Section: Discussionmentioning

confidence: 99%

Acute bilateral uveitis and right macular edema induced by a single infusion of zoledronic acid for the treatment of postmenopausal osteoporosis as a substitution for oral alendronate: a case report

Tian

Wang

Lianyuan

et al. 2016

BMC Musculoskelet Disord

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BackgroundZoledronic acid-induced uveitis (ZAIU) is rare but severe, and has been recently considered part of an acute phase reaction. Only 15 cases have been reported since 2005. Here we describe a case with macular edema, which is the first reported case observed after long-term alendronate tolerance.Case presentationA 63-year-old Asian woman received her first intravenous zoledronic acid treatment for the management of postmenopausal osteoporosis as a more convenient substitute for oral alendronate. Twenty-four hours later, bilateral eye irritations, periorbital swelling, blurred vision, and diplopia presented. The complete blood count and transaminase levels were normal, but the erythrocytic sedimentation, C-reactive protein, and serum C4 levels were elevated. On detailed ophthalmological examination, a diagnosis of bilateral acute uveitis and macular edema in the right eye was made. The ocular symptoms were not improved until administration of topical and oral steroids. Complete resolution was achieved. There was no rechallenge of bisphosphonates, and no recurrence at 6 months follow-up. Based on an extensive review, abnormal fundus is rarely reported, especially in cases of macular edema. Rechallenge with zoledronic acid in five cases induced no additional uveitis, and changing the medication to pamidronate in another patient was also tolerated. Interestingly, our patient suffered from uveitis soon after intravenous zoledronate exposure after a two-year tolerance to oral alendronate.ConclusionsThis is the first report of zoledronic acid induced uveitis with macular edema after long-term alendronate tolerance. Prior oral alendronate may not entirely prevent ZAIU. Steroids are usually necessary in the treatment of ZAIU. Bisphosphonate rechallenge is not fully contraindicated, and prior steroid administration may be a more reasonable treatment choice according to the available evidence.

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“…Bisphosphonates exert antiresorptive effect by suppression of osteoclast function via specifically binding to hydroxyapatite at sites of high bone turnover, leading to reduced bone absorption and increased bone mineral density (BMD). Bisphosphonates are indicated for osteoporosis, hypercalcemia of malignancy, Paget's disease of bone [1], multiple myeloma [2], and metastatic bone cancer from solid tumors [3]. Among bisphosphonates, zoledronate is frequently prescribed for patients who do not tolerate oral bisphosphonates or have metastatic bone disease because of its lower frequency of administration and higher potency.…”

Section: Introductionmentioning

confidence: 99%

Zoledronate-induced acute anterior uveitis: a three-case report and brief review of literature

et al. 2021

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Purpose This three-case report aims to highlight the ocular adverse effects induced by bisphosphonate therapy and to call clinicians’ attention. Methods Three cases of acute anterior uveitis secondary to the initial dose of zoledronate infusion were reported with focus on their symptoms, treatment regimens, and outcomes. A review of published reports provided a basis for discussion. Results Three cases of acute anterior uveitis were either bilateral or unilateral. They demonstrated typical manifestations of bisphosphonate-induced acute anterior uveitis such as eye pain, blurred vision, conjunctival and ciliary hyperemia, keratic precipitates, and flare in the anterior chamber. After topical corticosteroid-containing comprehensive treatments, these symptoms resolved completely without any vision loss and long-term sequelae. Conclusions Acute anterior uveitis may be part of the acute phase reaction induced by zoledronate. Patients should be informed of its symptoms in advance and be monitored closely during and after administration. Clinicians should have a good awareness of the zoledronate-associated acute anterior uveitis and to treat it in a prompt and appropriate manner.

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Acute uveitis following zoledronic acid infusion

Cited by 8 publications

References 6 publications

Zoledronic acid induced unilateral anterior uveitis

Zoledronic acid induced unilateral anterior uveitis

Acute bilateral uveitis and right macular edema induced by a single infusion of zoledronic acid for the treatment of postmenopausal osteoporosis as a substitution for oral alendronate: a case report

Zoledronate-induced acute anterior uveitis: a three-case report and brief review of literature

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