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  • Title: [Cataracts].
    Author: Hachet E.
    Journal: Bull Soc Ophtalmol Fr; 1985 Nov; Spec No():87-107. PubMed ID: 2866044.
    Abstract:
    10 types of drugs in current use believed to induce cataracts are identified and the evidence of their role is presented. Allopurinol, an antihyperuricemic used to treat gout, may induce cataracts in young subjects after longterm treatment. Experimental results suggest a relationship between the rate of circulating allopurinol, the extent of exposure to ultraviolet light, and perhaps individual susceptibility. Amiodarone hydrochloride is a benzofurane derivative used to combat cardiac arrhythmia since 1960. Cataracts are infrequently observed in users and the complication may be encouraged by association with other medications. Use of anticholinesterasics to treat chronic or acute glaucoma leads to cataracts in 20-50% of cases according to different workers. The rate is about the same for all anticholinesterasics but may be higher in older subjects. The drugs should not be used if the tension can be controlled by parasympathicomimetics and epinephrine or perhaps carbon anhydrase inhibitors. If they are used, the patient should be carefully examined every 6 months for vacuoles. The smallest possible dose should be used. Synthetic antimalarials, the chelator deferoxamine, inorganic mercury, and the phenothiazines have all been associated with cataract formation. The risk of cataracts associated with corticoids increases with the amount of the daily dose and the duration of treatment, with individual susceptibility apparently also playing a role. Sex is not a factor but young children may be at greater risk. Among the cytostatics, the alkylants have been implicated in development of ocular lesions, although the metaphase inhibitor vincristine has been shown in vitro to be responsible for cataracts as well. There is some evidence that diphenyl hydantoine used with phenobarbitol to treat epilepsy may induce cataracts. Some cases of cataracts have been reported in young women using combined oral contraceptives (OCs) for whom no other etiology was found. The implicated OCs had higher hormonal contents than those currently in use. A prospective study by Faust and Tyler did not uncover any evidence of the etiologic role of OCs, but elsewhere a case was reported in which evolving cataracts were stabilized on termination of OC use. Another study found no increase in opacities after 6 months of treatment with OCs. Experimental evidence of a link was found in rabbits but the doses were so high that they cannot be considered to confirm a toxic effect in women using OCs. It appears difficult to establish a relationship except of coincidence between OC use and appearance of cataracts. OCs should not be reported to cause cataracts only because no other etiology has been found.
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