Rare occurrence of acute bilateral cataract in young female patient with diabetes

India: A recent case report published in the Journal of the Association of Physicians of India describes the case of a female patient with type 1 diabetes and celiac disease who developed an acute bilateral cataract.

Cataract represents one of the most frequent eye complications in type 1 DM and type 2 DM patients; contrarily, acute cataract in young diabetic patients occurs very rarely. Only a few cases with acute bilateral cataract - all relatively shortly after the diagnosis of type 1 DM have been reported. It can affect visual acuity from slight visual impairment to complete blindness. Although usually associated with chronic hyperglycemia, it may also occur on the rapid restoration of euglycemia. Early detection of diabetes and adequate glycaemic control, particularly in female adolescents, may prevent this debilitating complication of diabetes.

In the current case, the 21-year-old female was diagnosed as type 1 DM/Celiac disease 3 yrs back when she presented with complaints of polyuria, polydipsia, weight loss and put on insulin therapy.3 months back patient developed sudden blurring of vision in both eyes which progressed over a duration of 7 days. On ophthalmologic examination, visual acuity was found to be restricted to hand movements in both eyes. There was no history of previous eye problems and visual acuity was normal in both eyes at the start of treatment. Slit-lamp biomicroscopy revealed dense cortical cataracts bilaterally. No fundus details were visible in either eye.

She was diagnosed as having bilateral acute irreversible metabolic cataract. She had no antecedent trauma, life-threatening diarrhea, or renal failure, and no exposure to drugs known to be associated with cataracts, such as steroids, barbiturates, phenothiazines, and diuretics. There were no features to suggest chronic hypocalcaemia, or a family history of cataracts, DM, Celiac disease, thyroid disorder or rheumatoid arthritis. The HbA1c level was 8.9% (NV-<6.5%) and FPG -285 mg/dl (NV-<126mg/dl).B.urea-28mg/dl (20-40mg/dl), S.creatinine-0.8mg/dl (0.5-0.9mg/dl), Na+-142meq/l (135-155meq/l), k+-4.2meq/l (3.5-5.5meq/l). Hemogram revealed Hb-10gm/dl (12.0-15.8), tlc-9400(3.54-9.06 x 103), dlc-neutrophils-69/lymphocytes-28/basophils-01/eoinophils-02(neutrophils-40-70%/lymphocytes-20-50%/basophils-0-6%/eosinophils-0-2%).

Urine examination revealed sugar 4+, ketone bodies were absent. UGI endoscopy revealed a flattening of the duodenal fold. Duodenal biopsy showed focal areas of villous atrophy along with inflammatory cells in lamina propria. Anti tTg antibody levels were 140units/ml (>9 units/ml is considered positive for celiac disease). The patient was treated with bilateral phacoemulsification once sugar levels fell within normal limits.