Clinical features, treatment, and prognosis of zoledronic acid-induced uveitis

Uveitis is a rare ocular adverse reaction of zoledronic acid, the specific clinical features are not clarified. This study was to investigate the clinical features of zoledronic acid-induced uveitis and provide reference for rational use of zoledronic acid.

We collected clinical data on zoledronic acid-induced uveitis for retrospective analysis by searching Chinese and English data up to October 31, 2024.

Uveitis occurred in 44 patients with a median age of 66.5 years (range 47, 87) and 93.2% in females. The median time to onset of uveitis was 48 h (range 10, 192). Eye pain (86.4%), decreased vision (61.4%), and redness (50.0%) were the most commonly described symptoms. Uveitis could involve unilateral eyes (68.2%) and bilateral eyes (31.8%), and anterior uveitis was the main type (95.5%). Most patients had intraocular pressure within the normal range. Slit lamp examination mainly revealed cells (54.5%), flare (43.2%), and keratic precipitates (29.5%). After discontinuation of zoledronic acid (97.6%) and receipt of topical steroids (97.7%), systemic steroids (15.9%), and cycloplegics (72.7%), all patients showed improvement or recovery.

Zoledronic acid-induced uveitis mainly occurs within 72 h after the initial administration, and anterior uveitis is predominant. When zoledronic acid is used, patients should be informed of possible adverse eye reactions. Topical corticosteroids can be used as the main treatment for uveitis.