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

Bilateral Cataract after Taking Oxcarbazepine

• Kim HJ
• Jung NY
• Yang CM
• Chung TY
• Lim DH

• KMID: 2445144
• DOI: http://doi.org/10.3341/jkos.2019.60.5.486

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

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  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.

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

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  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.

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  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.

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