Methotrimeprazine-induced Corneal Deposits and Cataract

Jae-Woong Koh (MD/PhD)

Seong-Taeck Kim (MD)

Department of Ophthalmology,

Chosun University College of Medicine,

Gwangju, Republic of Korea

Chosun University College of Medicine

Republic of Korea

• Dr. Koh • Dr. Kim

CASE REPORT• M / 48

• C/C : visual disturbance (Onset : 6 month ago)

• P/Hx : Medication for Schizophrenia (3 yrs)- 3 mg/day of haloperidol (thioxanthenes family)- 6 mg/day of risperidone (molindone family)

• Best Corrected Visual Acuity - Right : 20/40- Left : 20/50

CASE REPORT

Fine, discrete, and brownish deposits

on the posterior cornea

CASE REPORT

Bilateral star-shaped anterior sub-capsular lens opacities

Dense dust-like granular deposits

CASE REPORT

• Patient denied but might have taken the drugs of the phenothiazine family?- Drug Profiling Test by urine samples

CASE REPORT • Pursing the past history

- Patient had taken methotrimeprazine habitually from a different doctor for about 10 years

• Diagnosis- Drug-induced corneal deposits and cataract

• Procedure- Phacoemulsification with posterior chamber

foldable intra-ocular lens implantation in both eyes

• Outcome (After 3 years of operation)- Visual acuity improved to 20/20 in both eyes

Discussion• The uses of Phenothiazines

- in schizophrenia

- in manic phases of bipolar disorder

- in the treatment of nausea (low dose)

• The Family of Phenothiazine - Chlorpromazine- Methotrimeprazine

• Long-term medication of phenothiazine- accumulates 50 times higher blood concentration (in the ocular tissue >>> in other tissues of the body)

Chlorpromazine-induced Corneal deposits and Cataract

• Greiner and Berry

- First described (1964)

- Long-term medication of chlorpromazine

- Brown granular pigmentation in cornea

- Central star-shaped opacity in the center

of anterior capsular lens

Can Med Assoc J 1964; 90:663-665

Discussion

• Chlorpromazine-induced Corneal deposits and

Cataract

- some cases reported

• However !!!Methotrimeprazine-induced Corneal deposits and

Cataract

- Unusual and Rare case / specially confirmed by Drug Profiling Test by urine samples