Bilateral cataracts as the first manifestation of type 1 diabetes mellitus

Abstract

Rationale:Cataracts can occur in children and adolescents with Type 1 Diabetes Mellitus who have poorly controlled glycemia. Here, we report a case of a 16-year-old female, who was diagnosed with bilateral cataracts, and genetic screening identified a mutation in the PRRC2A gene which is rarely reported. After surgery, retinopathy was found in this patient, combined with the published literature, we encourage that postoperative monitoring for retinal lesions during the follow-up visits should be conducted.Patient concerns:In this article, we present an adolescent diagnosed with bilateral cataracts, and developed retinopathy during the follow-up visits. Genetic screening identified a mutation in the PRRC2A gene.Diagnoses:The diagnoses of Diabetic cataracts, Type 1 diabetes and Diabetic retinopathy was made.Interventions:The patient underwent surgery in both eyes, and hypoglycemic treatment was provided.Outcomes:The surgery achieved satisfactory results, during the follow-up visits, her visual acuity was reported as 0.8 in the right eye and 1.0 in the left eye. Besides, her blood glucose was well controlled, and her glycated hemoglobin was reduced to 6.9% after three months of continuous treatment.Lessons:This case highlights the importance of genetic screening for detecting mutations in diabetes-related genes, and postoperative monitoring for retinal lesions during the follow-up visits.

High Risk of Early Cataracts in Young Type 1 Diabetes Group: A Nationwide Cohort Study

“…Because retinopathy is considered to take at least 5 years to develop after the onset of hyperglycemia, the latest guideline of American Diabetes Association suggests eye examination 3–5 years after diabetic onset [ 2 , 28 ]. However, nearly all articles addressing diabetic cataracts deemed that it might tend to occur early in the course of T1D [ 14 – 18 , 30 – 32 ]. In our study, the hazard ratio of diabetic cataracts was tremendously high in the young group and then declined gradually as senile cataracts developed in the general population.…”

“…Given that most hypotheses require a period of time for cataracts to develop, they could not fully explain why some patients developed cataracts shortly after contracting T1D. Genetic predisposition was suggested, and some candidate genes pertaining to diabetic cataract have been found [ 14 , 32 ].…”

“…Our study also revealed such a trend. It has been suggested that increased levels of aldose reductase in females might contribute to the higher prevalence [ 14 ], but the real mechanism is still not fully understood.…”

“…On account of its rising incidence in those after 60 years of age, cataracts are customarily associated with type 2 diabetes as opposed to type 1 diabetes (T1D) [ 2 , 13 ]. However, it is not uncommon for clinicians to diagnose cataracts in young T1D patients, among some even preceding their T1D presentations [ 14 – 17 ]. The prevalence varies greatly between 0.7% and 29% [ 18 , 19 ].…”

Diabetes related cataract and histopathological abnormalities of the ocular regions of Wister albino rats

“…Poor diabetic-treatment resulted in impairment of visual acuity [4] and the development of cataract in child hood [5,6]. Cataractous lenses were also reported in diabetic experimental animal [7].…”