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Acute unilateral anterior uveitis and scleritis following a single infusion of zoledronate for metastatic breast cancer
Author(s) -
Moore Melissa M,
Beith Jane M
Publication year - 2008
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2008.tb01658.x
Subject(s) - medicine , breast cancer , ophthalmology , oncology , cancer
isp co cae Their me B hosphonates are indicated for treatment of a number of nditions, including osteoporosis, Paget’s disease, hypercalmia associated with malignancy, and bone metastases. chanism of action is via inhibition of osteoclast activity, leading to reduced bone resorption. Common side effects of bisphosphonate treatment are dysphagia, heartburn and oesophagitis. Since the early 1990s, there have been a number of case reports documenting various ocular complications of bisphosphonate use, including conjunctivitis, scleritis, iritis and uveitis. In most cases, ocular symptoms began within 72 hours of administration of the bisphosphonate, and symptoms generally improved after local therapy and cessation of the drug. Usually it is the nitrogencontaining bisphosphonates that have been implicated (alendronate, pamidronate, zoledronate, risedronate), but in one report uveitis was associated with a non-nitrogen-containing bisphosphonate (clodronate).5 The mechanism of the inflammation is unclear, but it is known that the nitrogen-containing bisphosphonates cause elevated levels of pro-inflammatory cytokines, including tumour necrosis factor α and interleukin-6. The factors that predispose some patients to develop ocular symptoms are not known. Management of patients with ocular complications of bisphosphonate use includes treatment with an ocular topical mydriatic drug and a steroid. In most of the cases described in these case reports, the bisphosphonate treatment was stopped, and, in one case, ocular symptoms recurred on rechallenge with the drug. In another case, in which the original bisphosphonate was replaced by a different drug of the same class, eye inflammation was reduced and eventually resolved with continued use, suggesting the development of immunological tolerance. Between 1997 and April 2004, there were nearly 6 million Pharmaceutical Benefits Scheme prescriptions filled in Australia for bisphosphonates. This figure underestimates overall use, as it does not capture bisphosphonates administered to hospital inpatients. Bisphosphonates are an extremely useful class of drugs, and the point of our case report is not to advocate lesser use, but to highlight the importance of early recognition of potentially sightthreatening ocular conditions, as they are readily treatable.