Transient hyperopia with lens swelling at initial therapy in diabetes.

Abstract

The clinical courses of 10 eyes of five diabetic patients who exhibited bilateral transient hyperopia (maximum: 1-1-4*9 dioptres, spherical equivalent) after initiation of strict control of diabetes with or without insulin are reported. The hyperopia occurred within a few days after abrupt decrease in plasma glucose, progressed to maximum at days 7-14, and regressed gradually over 1 month thereafter. Transient cycloplegia had no effect on refractive error. During hyperopia, there were no significant changes in axial length or corneal curvature. However, thickened lens, decreased anterior chamber depth, and transient cataract were observed to significant degrees. It is suggested that the transient hyperopia, with lens swelling and opacity, was caused by decreased lens refractive index following water influx.

Acute Incapacitating Hyperopia during Hypoglycemic Treatment

“…Detailed ophthalmological examination swelling with hyperopic refractive changes. This is a possible hypothesis for explaining the occurrence of transient hyperopic changes which is supported by Saito et al [1], whereas, debated by Okamoto [2].…”

“…The association of myopia with hyperglycaemia and hyperopia with hypoglycaemia have been reported in diabetic patients [3]. There are studies which show that an abrupt reduction in plasma glucose in diabetic patients with marked hyperglycaemia, induce transient hyperopia [1,2,4]. It has been seen that the degree of hyperopia is highly dependent on the magnitude of the change in plasma glucose concentration [2].…”

“…Many authors, who investigated the effect of acute changes in plasma glucose level, have reported that decreasing plasma glucose levels cause hyperopic changes [1,5,6]. Although some conflicting reports are there, recently, several papers have reported an abrupt reduction in plasma glucose in diabetic patients with marked hyperglycaemia induced transient hyperopia [1,2,4]. It has been seen that the degree of hyperopia is highly dependent on the magnitude of the change in plasma glucose concentration [2].…”

“…The difference in osmotic pressure results in the influx of water from the aqueous humour into the lens, causing lenticular Introduction P atients with diabetes mellitus can develop various ocular complications such as cataract, retinopathy, optic neuropathy, uveitis, and keratopathy etc. In addition, transient refractive error occurs during the course of diabetes mellitus and is associated with treatment induced changes in the plasma glucose concentration [1,2]. The association of myopia with hyperglycaemia and hyperopia with hypoglycaemia have been reported in diabetic patients [3].…”

“…Regarding chronic refractive changes in diabetic patients, Duke-Elder reported that hyperglycaemia led to the development of myopia, while hypoglycaemia led to the development of hyperopia [3]. Many authors, who investigated the effect of acute changes in plasma glucose level, have reported that decreasing plasma glucose levels cause hyperopic changes [1,5,6]. Although some conflicting reports are there, recently, several papers have reported an abrupt reduction in plasma glucose in diabetic patients with marked hyperglycaemia induced transient hyperopia [1,2,4].…”