¹Maisam Musgrave, ²Annie Thomas, ¹Maisam Musgrave

¹Mediclinic Parkview Hospital, ²Mediclinic Ibn Batoota

Background(s):

Acute anterior uveitis is a recognized rare complication that can occur following the administration of intravenous Zoledronic acid, which is used in treating osteoporosis and other bone related conditions.(1)

Method(s): We are presenting a case of a 60-year-old female patient who was diagnosed with an osteoporotic insufficiency fracture of the left distal radius. DEXA scan confirmed a T-score of -2.8 in the lumbar spine and -2.6 in the femoral neck. She had a history of osteoarthritis, a previous LASIK treatment approximately 6 years earlier but no underlying autoimmune disease.

She unfortunately experienced marked gastrointestinal side effects to alendronic acid and as a result was given intravenous zoledronic acid (5 mg over 30 minutes) as an alternative therapy. However, one day post infusion, she experienced flu-like symptoms, including bony aches and a low-grade fever, followed by the onset of right eye pain and redness two days later.

Clinically she had diffuse congestion of the right eye, no epithelial staining, no stromal oedema and fine diffuse Keratic Precipitates at the back of the cornea. She also had little aggregation of cells in the anterior chamber and early posterior synechiae. Her Intraocular pressure was normal.

Her medications included weekly 10,000 units vitamin D, daily 600 mg calcium, over-the-counter vitamin C and zinc. No new medications were initiated apart from the zoledronic acid.

Pre infusion labs including calcium, vitamin D, parathyroid hormone, creatinine, EGFR and full blood count were normal. She was subsequently tested for HLA-B27, and this was negative.

Result(s): The clinical findings were in keeping with acute non-granulomatous anterior uveitis. The patient was commenced on topical corticosteroid eye-drops which provided significant relief. Additionally, cyclopentolate eye drops were added, resulting in the breakdown of synechiae. Her condition resolved completely within 2 weeks.

Conclusion(s): Acute anterior uveitis (AAU) has been reported in approximately 0.8 to 1.1% of cases (2,3). Symptoms include ocular pain, blurred vision, photosensitivity with flares, hyperemia, ciliary spasm, and synechiae.

Onset of AAU usually occurs 2-4 days after the infusion. The etiology remains unclear but is likely to result from the activation of immune T cells and macrophages (3). Recommended treatments include ocular corticosteroids and cycloplegics.

Symptoms gradually improve with a mean duration of corticosteroid treatment of about 4 weeks with no long-term sequelae during follow-up ranging from 3 to 13 months post-infusion (4).

Acute anterior uveitis (AAU) is a rare yet serious complication that may occur following the administration of intravenous zoledronate therapy for osteoporosis. Before initiating therapy Clinicians should provide patients counselling regarding this condition. Early diagnosis and prompt therapy are essential for minimizing visual complications.