J Korean Ophthalmol Soc JKOS Journal of the Korean Ophthalmological Society 0378-6471 2092-9374 The Korean Ophthalmological Society 10.3341/jkos.2019.60.5.486 Case Report Bilateral Cataract after Taking Oxcarbazepine Kim Hyo Jeong MD 1 Jung Na Yeon MD 1 Yang Chan Min MD 1 Chung Tae-Young MD PhD 1 Lim Dong Hui MD PhD 1 2 Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Department of Preventive Medicine, Graduate School, The Catholic University of Korea, Seoul, Korea. Address reprint requests to Dong Hui Lim, MD, PhD. Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: 82-2-3410-5478, Fax: 82-2-3410-0074, ldhlse@gmail.com 05 2019 15 05 2019 60 5 486 490 07 06 2018 25 08 2018 23 04 2019 ©2019 The Korean Ophthalmological Society 2019 The Korean Ophthalmological Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.

 Anti epileptic drugs Oxcarbazepine Subcapsular cataract National Research Foundation of Korea 10.13039/501100003725 NRF-2018R1D1A1A02045884

This work was supported by the National Research Foundation of Korea grant funded by the Korea government Ministry of Education (NRF-2018R1D1A1A02045884; Seoul, Korea), which was received by DHL.

 Stables JP Bialer M Johannessen SI Progress report on new antiepileptic drugs. A summary of the Second Eilat Conference Epilepsy Res 1995 22 235 246 Tecoma ES Oxcarbazepine Epilepsia 1999 40 Suppl 5 S37 S46 Bill PA Vigonius U Pohlmann H A double-blind controlled clinical trial of oxcarbazepine versus phenytoin in adults with previously untreated epilepsy Epilepsy Res 1997 27 195 204 Guerreiro MM Vigonius U Pohlmann H A double-blind controlled clinical trial of oxcarbazepine versus phenytoin in children and adolescents with epilepsy Epilepsy Res 1997 27 205 213 Christe W Krämer G Vigonius U A double-blind controlled clinical trial: oxcarbazepine versus sodium valproate in adults with newly diagnosed epilepsy Epilepsy Res 1997 26 451 460 Friis ML Kristensen O Boas J Therapeutic experiences with 947 epileptic out-patients in oxcarbazepine treatment Acta Neurol Scand 1993 87 224 227 McLean MJ Schmutz M Wamil AW Oxcarbazepine: mechanisms of action Epilepsia 1994 35 Suppl 3 S5 S9 May TW Korn-Merker E Rambeck B Clinical pharmacokinetics of oxcarbazepine Clin Pharmacokinet 2003 42 1023 1042 van den Brûle J Degueldre F Galand A Drug-induced cataracts Rev Med Liege 1998 53 766 769 Berman ER Biochemistry of the Eye 1st ed Berlin Springer Science & Business Media 1991 chap. 5 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 Brown M Bennett P Clinical pharmacology 11th ed London Churchill Livingstone Elsevier 2008 349 370 Flesch G Overview of the clinical pharmacokinetics of oxcarbazepine Clin Drug Investig 2004 24 185 203 Banergee S Ghosh J C sil PC Drug metabolism and oxidative stress: cellular mechanism and new therapeutic insights Biochem Anal Biochem 2016 5 255 Pham-Huy LA He H Pham-Huy C Free radicals, antioxidants in disease and health Int J Biomed Sci 2008 4 89 96 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. Anterior segment photography at the first visit. It shows cortical opacity and subcapsular cataract on her both eyes. 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. 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.