Cataracts and Quetiapine

Mr. A was a 44-year-old Latin American man with a 20-year history of schizophrenia and minimal response to fluphenazine, haloperidol, thioridazine, chlorpromazine, loxapine, and olanzapine. Clozapine treatment had resulted in agranulocytosis, necessitating discontinuation. Partial response had been achieved with risperidone, up to 10 mg/day; however, hostility and anxiety had persisted. Marked improvement in mood with decreased anxiety and hostility had been noted after the addition of quetiapine to risperidone therapy. The results of eye examinations at baseline, 6 months, and 12 months were unremarkable. Fifteen months after the addition of quetiapine, an optometry examination revealed lenticular changes in the left eye and grade I cortical spoking in the interior aspect of the lens (2). Quetiapine was tapered off over 9 days, and an eye examination conducted 1 month later showed no progression of cataract formation.

Soon after he stopped taking quetiapine, Mr. A became more anxious and had less behavioral control, requiring more use of anxiolytics. He and the treatment team evaluated the risks versus the benefits and decided that the combination of quetiapine and risperidone had provided the best response. Quetiapine was reintroduced at 700 mg/day, resulting in decreased hostility and anxiety and only occasional irritability. An eye examination then revealed water vacuoles in both lenses, suggesting cataract formation (3). Despite these lenticular changes, therapy with quetiapine, 700 mg/day, and risperidone, up to 10 mg/day, was maintained, which continued to control Mr. A’s symptoms. A later eye examination revealed no changes in the previous findings.