Background: Zoledronic acid is a bisphosphonate used to treat osteoporosis, metastatic bone lesions associated with solid tumors, and hypercalcemia as a complication of malignant tumors. We present a case of bilateral acute anterior uveitis after infusion of zoledronic acid and review this case with available literature.
Case presentation: A 77-year-old woman underwent intravenous administration of zoledronic acid for osteoporosis in a local internal medicine clinic, on November 14, 2017. On day three, she noticed left eye hyperemia. Six days after administration, she visited our clinic (Sofukai Oppama Ekimae Eye Clinic) due to worsening hyperemia and ocular pain. Her vision was Vd= (0.7), Vs= (0.5); ciliary hyperemia, corneal edema, posterior corneal deposits, anterior chamber inflammatory cells and angle hypopyon were noted. Mild vitreous opacity was noted; however, there were no fundal abnormalities. We started treatment with betamethasone administration to the left eye. On day seven, the patient noticed ciliary hyperemia of the right eye, and anterior chamber inflammatory cells were observed. Inflammation subsided with the instillation and her visual acuity improved. There was no recurrence of inflammation following eye drop withdrawal.
Conclusions: Although the incidence of uveitis as a side effect of zoledronic acid administration is～1%, there are hardly any reports in Japan. With increasing use of bisphosphonates, ophthalmologists, as well as primary users, should be aware of potential ocular side effects of these drugs.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 123: 603-607, 2019.