ANTERIOR UVEITIS FROM ZOLEDRONIC ACID 

NEW YORK (Reuters Health) Jan 21 - About one in 100 patients could develop acute anterior uveitis (AAU) in the week after receiving intravenous zoledronate, researchers from New Zealand report.

"The study was the first to quantify the incidence of AAU following zoledronate infusion," Dr. Dipika V. Patel from New Zealand National Eye Center at the University of Auckland told Reuters Health by email. "This has enabled us to improve patient consent, and we now routinely inform our patients that the risk of developing AAU following their first infusion is approximately 1%."

Dr. Patel and colleagues used data from a large randomized controlled trial investigating the efficacy of intravenous zoledronate in fracture prevention in 2,001 osteopenic postmenopausal women to assess the incidence of ocular side effects. Their findings appear online January 4 in Ophthalmology.

Ten women developed painful red eye (9 of 1,001 after zoledronate, 1 of 1,000 after placebo), but only 8 (all of them assigned to zoledronate) accepted referral to an ophthalmologist. All 8 were diagnosed with AAU (6 mild to moderate, 2 severe).

Their symptoms developed an average of three days after the zoledronate infusion (range, 1-7 days), and none of them had a previous history of uveitis.

Treatment with prednisolone acetate for a median 47 days (range, 12-94 days) brought relief of symptoms and improvement of mean best-corrected visual acuity from 20/30 at presentation to 20/25 at resolution of uveitis.

There were no long-term sequelae, and one woman went on to have a second zoledronate infusion 18 months later and experienced no ocular symptoms.

"Currently, there are no published data regarding the incidence of AAU following a second infusion," Dr. Patel said. "We therefore routinely arrange ophthalmic review for patients 3 days after a second infusion if they developed AAU after their first infusion."

"We are currently performing a large prospective study that aims to further investigate the incidence and nature of AAU following zoledronate infusion," Dr. Patel said. "We are also analyzing the effects of a second infusion in patients who developed AAU after their first infusion."

"This is a reminder to physicians that bisphosphonates can cause eye inflammation," said Dr. Rick Fraunfelder from the Department of Ophthalmology at Oregon Health Sciences University, Portland. "These include conjunctivitis, iritis, uveitis, episcleritis, and scleritis."

"The only vision-threatening adverse reaction is scleritis and the drug should be discontinued if this occurs," Dr. Fraunfelder told Reuters Health by email. "For any of the other eye conditions, the drug may be continued and referral to an ophthalmologist for possible therapy with topical ocular steroids is indicated."

Dr. Fraunfelder added, "Osteonecrosis and scleritis appear to be the most common adverse events reported for this class of medication and only came to light after the drug was marketed. Patients and physicians need to continue to remain vigilant in noticing possible adverse events and report them to the FDA or to our database www.eyedrugregistry.com if the event is eye related."

SOURCE: http://bit.ly/10Ltrcg

Ophthalmology 2013.