Rapid Formation Of Cataract After Starting Ziprasidone With Spontaneous Regression After Therapy Was Discontinued
Chou, Timothy Y. MD*; Bricel, Seth MD; Yazdanie, Mohammad MD. Rapid formation of cataract after starting ziprasidone with spontaneous regression after therapy was discontinued. Journal of Cataract and Refractive Surgery Online Case Reports 7(3):p 48-51, June 2019. | DOI: 10.1016/j.jcro.2019.04.002
View Original Source →Abstract
A 48-year-old diabetic woman with bipolar disorder presented with rapid onset of blurred vision after starting the antipsychotic drug ziprasidone. On examination, she was found to have advanced cataracts with a prominent posterior subcapsular component. Because her preoperative blood sugar levels had become elevated while on ziprasidone, the patient discontinued the medication before uneventful cataract surgery in the right eye. Postoperatively, the blood sugar level was improved; simultaneously, she noticed an improvement in vision in not only her operated eye but also her unoperated left eye. Examination showed near-complete resolution of the cataract in the left eye. We propose that initiation of therapy with ziprasidone in this patient promoted formation of bilateral cataracts, possibly through its hyperglycemic effect, while its cessation led to cataract regression in the unoperated eye.
Case Details
Disease Location
Bilateral eyes
Personal Characteristics
48-year-old woman, 6 months history of ziprasidone for bipolar disorder (80mg/12h). Diabetes for 9 years (uncontrolled by the moment of consulting), hyperlipidemia, obesity, hypertension, hashimoto thyroiditis, asthma, and smoking. Alprazolam, atenolol, gabapentin, canagliflozin, levothyroxine, lisinopril, oxycodone–acetaminophen, insulin, and liraglutide
Clinical Characteristics
Chief complaint of “severely blurry vision for the past 3 days, like everything is in a cloud.” the patient’s initial corrected distance visual acuity was 20/80 in the right eye and 20/60 in the left eye. The slitlamp examination was significant for bilateral 2c to 3c nuclear sclerosis combined with dense posterior subcapsular cataracts, which had an asym- metric petaloid pattern. 2 weeks before her cataract surgery, the patient’s antipsychotic medication was changed from ziprasidone to olanzapine 7.5 mg orally every day to see whether her blood sugar control might improve on a different agent. She had uneventful cataract surgery in the right eye.
Remission Characteristics
At the first postoperative visit, the patient reported noticing improved vision, not only in her operative eye but also in the un-operated left eye. Two months later, the left eye showed complete resolution of the posterior subcapsular component of the cataract, and only mild residual nuclear sclerosis remained. The patient’s blood sugar level was also improved, with the fasting blood sugar measured at 85 mg/dl shortly after cataract surgery and 81 mg/dl 4 months later.
Treatment & Mechanisms
Proposed Remission Mechanisms
Discontinuation of ziprasidone
Clinical Treatment
Right eye phacoemulsification for comorbidities: ziprasidone, alprazolam, atenolol, gabapentin, canagliflozin, levothyroxine, lisinopril, oxycodone–acetaminophen, insulin, and liraglutide