J Korean Ophthalmol Soc.  2019 May;60(5):486-490. 10.3341/jkos.2019.60.5.486.

Bilateral Cataract after Taking Oxcarbazepine

Affiliations
  • 1Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ldhlse@gmail.com
  • 2Department of Preventive Medicine, Graduate School, The Catholic University of Korea, Seoul, Korea.

Abstract

PURPOSE
To report a case of bilateral posterior subcapsular cataract after taking oxcarbazepine (Trileptal®, Novartis, Basel, Swiss).
CASE SUMMARY
A 19-year-old female visited our clinic with decreased vision in both eyes. Her best-corrected visual acuity was 0.3 in the right eye and 0.5 in the left eye, and slit-lamp examination revealed a bilateral cortical opacity and subcapsular cataract. She had been taking oxcarbazepine for epilepsy for 10 years, which was discontinued 3 years ago. Her mother had undergone cataract surgeries when she was approximately 46 years of age. No other risk factors for cataract were present.
CONCLUSIONS
In the present case, bilateral cortical opacity and subcapsular cataract were assumed to be associated with the use of oxcarbazepine. We suggest that oxcarbazepine could induce a cataract and recommend a regular follow-up by a qualified ophthalmologist.

Keyword

Anti epileptic drugs; Oxcarbazepine; Subcapsular cataract

MeSH Terms

Cataract*
Epilepsy
Female
Follow-Up Studies
Humans
Mothers
Risk Factors
Visual Acuity
Young Adult

Figure

  • Figure 1 Molecular structure of oxcarbazepine (10, 11-Dihydro-10-oxo-5H dibenzazepine-5-carboxamide). Oxcarbazepine is a structural derivative of carbamazepine, with a ketone in place of the carbon-carbon double bond on the dibenzazepine ring at the 10 position.

  • Figure 2 Anterior segment photography at the first visit. It shows cortical opacity and subcapsular cataract on her both eyes.

  • Figure 3 Optical coherence tomography and ultra-wide-field imaging at the first visit. (A) Disc and macular are clear and flat at bilateral retina. (B) The retina is within normal limit on ultra-wide-field imaging.

  • Figure 4 The chemical structures of oxcarbazepine and 10-monohydroxy metabolite (MHD). Oxcarbazepine is metabolized to MHD in human liver. MHD inhibits the cytochrome P450, which play a pivotal role in drug metabolism. The poor coupling of the cytochrome P450 catalytic cycle results in the continuous production of reactive oxygen species (ROS) which may oxidize the protein in the crystalline lens, and consequently creating cataracts.


Reference

1. Stables JP, Bialer M, Johannessen SI, et al. Progress report on new antiepileptic drugs. A summary of the Second Eilat Conference. Epilepsy Res. 1995; 22:235–246.
Article
2. Tecoma ES. Oxcarbazepine. Epilepsia. 1999; 40:Suppl 5. S37–S46.
Article
3. Bill PA, Vigonius U, Pohlmann H, et al. A double-blind controlled clinical trial of oxcarbazepine versus phenytoin in adults with previously untreated epilepsy. Epilepsy Res. 1997; 27:195–204.
Article
4. Guerreiro MM, Vigonius U, Pohlmann H, et al. A double-blind controlled clinical trial of oxcarbazepine versus phenytoin in children and adolescents with epilepsy. Epilepsy Res. 1997; 27:205–213.
Article
5. Christe W, Krämer G, Vigonius U, et al. A double-blind controlled clinical trial: oxcarbazepine versus sodium valproate in adults with newly diagnosed epilepsy. Epilepsy Res. 1997; 26:451–460.
Article
6. Friis ML, Kristensen O, Boas J, et al. Therapeutic experiences with 947 epileptic out-patients in oxcarbazepine treatment. Acta Neurol Scand. 1993; 87:224–227.
Article
7. McLean MJ, Schmutz M, Wamil AW, et al. Oxcarbazepine: mechanisms of action. Epilepsia. 1994; 35:Suppl 3. S5–S9.
Article
8. May TW, Korn-Merker E, Rambeck B. Clinical pharmacokinetics of oxcarbazepine. Clin Pharmacokinet. 2003; 42:1023–1042.
Article
9. van den Brûle J, Degueldre F, Galand A. Drug-induced cataracts. Rev Med Liege. 1998; 53:766–769.
10. Berman ER. Biochemistry of the Eye. 1st ed. Berlin: Springer Science & Business Media;1991. chap. 5.
11. Nita M, Grzybowski A. The role of the reactive oxygen species and oxidative stress in the pathomechanism of the age-related ocular diseases and other pathologies of the anterior and posterior eye segments in adults. Oxid Med Cell Longev. 2016; 2016:3164734.
Article
12. Brown M, Bennett P. Clinical pharmacology. 11th ed. London: Churchill Livingstone Elsevier;2008. p. 349–370.
13. Flesch G. Overview of the clinical pharmacokinetics of oxcarbazepine. Clin Drug Investig. 2004; 24:185–203.
Article
14. Banergee S, Ghosh J, C sil PC. Drug metabolism and oxidative stress: cellular mechanism and new therapeutic insights. Biochem Anal Biochem. 2016; 5:255.
Article
15. Pham-Huy LA, He H, Pham-Huy C. Free radicals, antioxidants in disease and health. Int J Biomed Sci. 2008; 4:89–96.
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