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Diabetic Cataract

Diabetes mellitus is a significant risk factor for the development of cataracts, the second most common ocular complication in this patient population. Various visual disturbances may be noted in diabetic cataract, and the diagnosis requires a slit-lamp examination.


Presentation

Cataracts are considered to be one of the earliest complications of diabetes mellitus, and they are confirmed as the most common cause of visual impairment in older age diabetics [1] [2]. Some studies report that female patients are more likely to develop a cataract, but the observed gender predilection is yet to be confirmed [3]. Other studies, however, report that poor glycemic control greatly contributes to the development of cataracts, particularly ketoacidosis, which can directly promote corneal damage by reducing the number of viable antioxidant molecules [3]. Compared to classical senile cataracts that have a slow development over a period of years [4], diabetic forms seem to have an earlier onset and a more progressive clinical course [3], with most important features being the development of posterior, anterior, subcapsular or cortical opacities of the cornea [3]. These pathological changes can affect only one eye, but cases of bilateral diabetic cataracts have been documented [3]. Loss of contrast, a necessity for more illumination to maintain adequate vision, issues with distinguishing dark blue from black color, as well as halos around lights, are most common complaints [4]. In severe cases, painless blurring and severe vision impairment can occur, and it is not uncommon for cataracts to cause blindness [3] [4] [5]. Swelling of the cataract may occur in rare cases and cause pain provoked by secondary closed-angle glaucoma, due to mechanical compression of the iris and the trabecular meshwork [4].

Myxedema
  • .- ) myotonia ( G71.1- ) myxedema ( E03.- ) protein-calorie malnutrition ( E40-E46 ) Diagnosis Index entries containing back-references to E11.36 : Diabetes, diabetic (mellitus) (sugar) E11.9 ICD-10-CM Diagnosis Code E11.9 Type 2 diabetes mellitus without[icd10data.com]
  • .- ) myotonia ( G71.1- ) myxedema ( E03.- ) protein-calorie malnutrition ( E40-E46 ) Diagnosis Index entries containing back-references to E10.36 : Diabetes, diabetic (mellitus) (sugar) E11.9 ICD-10-CM Diagnosis Code E11.9 Type 2 diabetes mellitus without[icd10data.com]
Overeating
  • Glasses & Contact Lenses Over 140 million people in the U.S. wear eyeglasses, and over 30 million wear contact lenses. Glasses and contact lenses improve vision by adjusting the way the eyes bend and focus light.[rockvilleeye.com]
  • HGF concentrations steadily increased over the month while IL-1 beta and PEDF concentrations demonstrated an acute rise on day 1 after surgery and then IL-1beta returned to baseline concentrations while PEDF decreased to below baseline.[ncbi.nlm.nih.gov]
  • Compared to classical senile cataracts that have a slow development over a period of years, diabetic forms seem to have an earlier onset and a more progressive clinical course, with most important features being the development of posterior, anterior,[symptoma.com]
  • Dilated eye examination can never be over emphasized in care of diabetic children. A dilated eye exam require administration of drops in the eye that dilate the pupil of the eye.[childhealth-explanation.com]
  • The disease is more common in people over 60, diabetics, those who are severely nearsighted and family members of people already diagnosed with glaucoma.[lasikdoctors.com]
Increased Appetite
  • ., a girl, aged 10 years, who entered the Michael Reese Hospital, May 19, 1922, had the usual symptoms of diabetes (loss of weight, increased thirst, increased appetite, polyuria, malaise and irritability).[jamanetwork.com]
Corneal Edema
  • PURPOSE: To compare levels of selected mediators in serums and aqueous humor (AH) of type 2 diabetes mellitus cataract patients with senile cataract patients, and to determine their association with postoperative corneal edema (CE).[ncbi.nlm.nih.gov]
  • On the first day postoperatively, diffuse corneal edema occurred with Descemet membrane striae, and the corneal epithelium detached on a large scale. Within 2 weeks, the cornea was clear with adherent epithelium and smooth Descemet membrane.[ncbi.nlm.nih.gov]
  • Particularly, investigators focused on the development of corneal edema as one of the main causes of low visual acuity in the immediate postoperative period after intraocular lens implantation.[clinicaltrials.gov]
  • Comparison of corneal edema caused by cataract surgery with different phaco times in diabetic and non-diabetic patients. Ann Ophthalmol (Skokie) 2006;38:61-5. 22. Suto C, Hori S, Kato S.[egyptretinaj.com]
Corneal Opacity
  • […] lens cloudiness or opacity corneal opacity retinal opacity Answer: A What is the symptom of cataract? pain blurring of vision squint Answer: B How do we treat cataract? surgery taking medication taking herbs Answer: A[pendidikanpesakit.myhealth.gov.my]

Workup

Cataracts can be confirmed by a slit-lamp examination that will identify yellow, gray or white opacities in the lens [4]. Other signs may include recurrent corneal erosions and ulcerations, increased autofluorescence and reduced corneal sensitivity, while the examination of the red reflex at a distance of around 30 cm from the affected eye through the use of an ophthalmoscope will confirm the presence of corneal opacities [2] [4]. Pupillary dilation before the eye examination is advocated, to obtain a better view of the entire apparatus and possibly detect other pathological changes, such as diabetic retinopathy [4]. Assessment of visual acuity, gonioscopy, funduscopy, and tonometry are other tests that can be employed, so that the exact type and location of the cataract may be determined [2]. In addition to physical examination, a detailed laboratory workup should be carried out in all patients with an undisclosed cause of cataract development, comprising serum glucose levels and hemoglobin A1C (HbA1c). Obtaining a proper family history that will potentially determine the presence of diabetes mellitus within the family or close relatives is also an important step when assessing patients with cataracts. Moreover, patients should be asked whether they exhibit some of the more common symptoms of diabetes (polyuria, polydipsia or polyphagia), the primary reason being the detection of diabetes.

Staphylococcus Aureus
  • aureus at 11.79% and 11.7%, respectively for Type 1, and 24.2% and 21.2% for Type 2. [29] There was a trend for a higher preponderance of coagulase-negative staphylococcal isolates in patients who had preexisting DR. [29] Phillips and Tasman found a[egyptretinaj.com]

Treatment

  • Four of the six patients had at least a six-month history of diabetic symptoms before the treatment was started, and five patients had ketoacidosis at initial admission to hospital.[ncbi.nlm.nih.gov]
  • References Early Treatment Diabetic Retinopathy Study Research Group . Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group .[care.diabetesjournals.org]
  • Prevention is the best treatment for diabetic retinopathy.[northfloridavision.com]
  • Diabetic Retinopathy treatment Depending on the severity of the condition, and how well it may respond to specific measures, treatment options vary. You may not need immediate treatment, or you could require surgery.[lasikdoctors.com]
  • There is currently no cure for ARMD, but there are several treatments that can slow or even stop its progression. These treatments range from nutritional supplements to doctor administered injections, depending on the stage of the disease.[wilsoneyecenter.com]

Prognosis

  • EUROTIMES STORIES Evolution of cataract surgery and management of diabetic retinopathy has resulted in improvement of prognosis following cataract surgery in diabetic patients.[eurotimesindia.org]
  • […] non-steroidal anti-inflammatory drugs in addition to routine topical steroid preparations, particularly in those with pre-existing macular oedema. 3 In summary, diabetes patients with mild to moderate diabetic retinopathy and no maculopathy have a good prognosis[cehjournal.org]
  • In general, the visual prognosis following cataract surgery in diabetic patients is favorable.[ncbi.nlm.nih.gov]
  • What's the prognosis for a person with diabetic eye disease? The earlier diabetic eye disease is diagnosed and treated (if necessary), the better the prognosis.[emedicinehealth.com]

Etiology

  • Abstract Aldose reductase (AR) has been implicated in the etiology of diabetic cataract, as well as in other complications.[ncbi.nlm.nih.gov]
  • Keywords: Diabetes mellitus/complications; Cataract/etiology; Hyperopia; Case reports [Publication type] RESUMO Paciente de 13 anos, com história recente de hiperglicemia, desenvolveu subitamente, catarata subcapsular posterior em ambos os olhos, consistindo[scielo.br]
  • Ophthalmology 108 : 1767 –1776, 2001 Chen CS, Miller NR: Ocular ischemic syndrome: review of clinical presentations, etiology, investigation, and management.[care.diabetesjournals.org]

Epidemiology

  • Information on possible benefits of putative anticataract agents comes from a variety of approaches, ranging from laboratory experiments, both in vitro and in vivo, to epidemiological studies in patients.[ncbi.nlm.nih.gov]
  • There is few recent cataract epidemiology study which focus on diabetic population especially in developed countries.[discovery.dundee.ac.uk]
  • Epidemiology of diabetic retinopathy. In; Management of diabetic retinopathy. London: BMJ Publishing Group; 1996. p. 1-15. 4. Kokiwar PR, Gupta S, Durge PM. Prevalence of diabetes in a rural area of central India.[meajo.org]
  • Many epidemiological and clinical studies documented the higher prevalence of cataract in diabetic patients [14, 15].[go.galegroup.com]
  • Arch Ophthalmol 102:520–526 PubMed CrossRef Google Scholar Klein R, Klein BE, Moss SE et al (1984b) The Wisconsin epidemiologic study of diabetic retinopathy. III.[link.springer.com]
Sex distribution
Age distribution

Pathophysiology

  • It is the first report of inhibition interaction between AR and iNOS, suggesting a new pathophysiological mechanism and providing a new insight into the therapeutic mechanism of DC. Copyright 2017 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • Pathophysiology of the immune system in elderly subjects with or without diabetes and variations after recombinant interleukin-2. Arch Gerontol Geriatr 1989;9:163-80. 27.[egyptretinaj.com]
  • Retina 1 : 27 –55, 1981 Christoffersen NL, Larsen M: Pathophysiology and hemodynamics of branch retinal vein occlusion.[care.diabetesjournals.org]

Prevention

  • All the findings above provide encouraging evidence for emodin as a potential therapeutic agent to prevent cataract in diabetic patients.[ncbi.nlm.nih.gov]
  • Implications resulting from these mechanisms for possible pharmacological interventions to prevent diabetic cataract are discussed.[ncbi.nlm.nih.gov]
  • Abstract Recently, substances possessing antioxidant can prevent cataractogenesis of diabetic cataract. Therefore, this study was carried out to determine the anticataract effect of Zea mays L.[ncbi.nlm.nih.gov]
  • These techniques offer new avenues for mechanistic evaluation and future prevention or therapy of DCs.[ncbi.nlm.nih.gov]
  • Diabetic Cataract Prevention of Cataract Progression Retinopathy -- Glaucoma -- Cataract -- Precise cause of diabetic cataract is yet under study.[childhealth-explanation.com]

References

Article

  1. Onakpoya OH, Bekibele CO, Adegbehingbe SA. Cataract surgical outcomes in diabetic patients: case control study. Middle East Afr J Ophthalmol. 2009;16(2):88.
  2. Javadi MA, Zarei-Ghanavati S. Cataracts in Diabetic Patients: A Review Article. J Ophthalmic Vis Res. 2008;3(1):52-65.
  3. Pakhetra R, Jyotsna V. Bilateral Early Cataracts in Type 1 Diabetes. Med J Armed Forces India. 2009;65(1):71-72.
  4. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  5. Pollreisz A, Schmidt-Erfurth U. Diabetic Cataract—Pathogenesis, Epidemiology and Treatment. J Ophthalmol. 2010;2010:608751.

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Last updated: 2019-06-28 11:44