Severe visual loss secondary to retinal toxicity after intravenous use of bisphosphonate in an eye with known chloroquine maculopathy.
OBJECTIVE
To describe a case of retinal toxicity after intravenous administration of the bisphosphonate medication zoledronic acid.


METHODS
A 61-year-old woman with known bull's eye chloroquine maculopathy presented with sudden decrease in vision within 1 week of receiving intravenous zoledronic acid (Aclasta). Complete ophthalmic examination including fundus photography, autofluorescence, optical coherence tomography, and visual field testing were performed over 1½ years of follow-up.


RESULTS
Decreased visual acuity, central visual field depression, and loss of the outer retinal layers on optical coherence tomography were seen in the symptomatic eye. The patient's last dose of chloroquine was over 15 years ago, with stable visual acuity and visual fields over this period, making chloroquine maculopathy an unlikely cause for the acute visual decline. The temporal association with the administration of intravenous zoledronic acid suggests a causative role for this mediation.


CONCLUSIONS
Exposure to zoledronic acid seems to have precipitated acute visual loss in an eye with known chloroquine toxicity after 15 years of quiescence. Retinal toxicity may represent a rare adverse reaction to zoledronic acid, but this case suggests that caution should be used when administering this medication to patients with compromised retinal integrity.
*Department of Ophthalmology, Western University, London, Canada; and †College of Medicine, University of Saskatchewan, Saskatoon, Canada.
Lulu L C D
LL
Bursztyn
Moness
M
Masri
Thomas G
TG
Sheidow
D018501:Antirheumatic Agents / Q000009:adverse effects*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D002738:Chloroquine / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D008875:Middle Aged; D012164:Retinal Diseases / Q000139:chemically induced*; D014786:Vision Disorders / Q000139:chemically induced*; D000077211:Zoledronic Acid
D018501:Antirheumatic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D002738:Chloroquine