Clinical Communications Pediatrics| Volume 58, ISSUE 4, e207-e209, April 2020

Acute Cataract Development in a Pediatric Patient With Type 1 Diabetes



      Type 1 diabetes mellitus (T1DM) is the most common form of diabetes mellitus in the pediatric population, with an estimated 500,000 children living with T1DM and an estimated 80,000 new cases each year in the United States. Ophthalmologic complications of diabetes are common in adult patients and those with longstanding disease, but can also be seen in patients with a recent diagnosis, even among the pediatric population.

      Case Report

      We present the case of a 13-year-old girl with recently diagnosed T1DM who presented to the pediatric emergency department with acute onset of bilateral blurry vision due to cataract formation. Prompt recognition of the condition and ophthalmologic consultation allowed for timely diagnosis and restorative surgery.

      Why Should an Emergency Physician Be Aware of This?

      We present this case to increase awareness among emergency physicians of the potential for cataract formation in pediatric patients with T1DM, as well as the fact that it may be the first presenting sign of the disease. Furthermore, emergency physicians should be aware that pediatric patients who present with severe T1DM, either with extremely high hemoglobin A1c or glycemic blood levels, are at increased risk for cataract formation and should be evaluated for subtle signs of cataract formation even in the absence of obvious cataracts. We also discuss the pathophysiologic theories of cataract formation in patients with T1DM.


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        • Craig M.E.
        • Jefferies C.
        • Dabelea D.
        • et al.
        ISPAD Clinical Practice Consensus Guidelines 2014. Definition, epidemiology, and classification of diabetes in children and adolescents.
        Pediatr Diabetes. 2014; 15: 4-17
        • Sayin N.
        • Kara N.
        • Pekel G.
        Ocular complications of diabetes mellitus.
        World J Diabetes. 2015; 6: 92-108
        • Geloneck M.M.
        • Forbes B.J.
        • Shaffer J.
        • Ying G.
        • Binenbaum G.
        Ocular complications in children with diabetes mellitus.
        Ophthalmology. 2015; 122: 2457-2464
        • Pollreisz A.
        • Schmidt-Erfurth U.
        Diabetic cataract-pathogenesis, epidemiology and treatment.
        J Ophthalmol. 2010; 2010: 608751
        • Wilson M.E.
        • Levin A.V.
        • Trivedi R.H.
        • et al.
        Cataract associated with type-1 diabetes mellitus in the pediatric population.
        J AAPOS. 2007; 11: 162-165
        • Klein B.E.
        • Klein R.
        • Moss S.E.
        Prevalence of cataracts in a population-based study of persons with diabetes mellitus.
        Ophthalmology. 1985; 92: 1191-1196
        • Uspal N.G.
        • Schapiro E.S.
        Cataracts as the initial manifestation of type 1 diabetes mellitus.
        Pediatr Emerg Care. 2011; 27: 132-134
        • Šimunović M.
        • Paradžik M.
        • Škrabić R.
        • Unić I.
        • Bućan K.
        • Škrabić V.
        Cataract as early ocular complication in children and adolescents with type 1 diabetes mellitus.
        Int J Endocrinol. 2018; 2018: 6763586
        • Ehrlich R.M.
        • Kirsch S.
        • Daneman D.
        Cataracts in children with diabetes mellitus.
        Diabetes Care. 1987; 10: 798-799
        • Datta V.
        • Swift P.G.
        • Woodruff G.H.
        • Harris R.F.
        Metabolic cataracts in newly diagnosed diabetes.
        Arch Dis Child. 1997; 76: 118-120
        • Phillip M.
        • Ludwick D.J.
        • Armour K.M.
        • Preslan M.W.
        Transient subcapsular cataract formation in a child with diabetes.
        Clin Pediatr (Phila). 1993; 32: 684-685
        • Brown C.A.
        • Burman D.
        Transient cataracts in a diabetic child with hyperosmolar coma.
        Br J Ophthalmol. 1973; 57: 429-433
        • Bilginturan A.N.
        • Jackson R.L.
        • Ide C.H.
        Transitory cataracts in children with diabetes mellitus.
        Pediatrics. 1977; 60: 106-109
        • Falck A.
        • Laatikainen L.
        Diabetic cataract in children.
        Acta Ophthalmol Scand. 1998; 76: 238-240
        • Kinoshita J.H.
        Mechanisms initiating cataract formation. Proctor Lecture.
        Invest Ophthalmol. 1974; 13: 713-724
        • Kinoshita J.H.
        Cataracts in galactosemia. The Jonas S. Friedenwald Memorial Lecture.
        Invest Ophthalmol. 1965; 4: 786-799
        • Kinoshita J.H.
        • Fukushi S.
        • Kador P.
        • Merola L.O.
        Aldose reductase in diabetic complications of the eye.
        Metabolism. 1979; 28: 462-469
        • Datiles M.B.
        • Kador P.F.
        Type I diabetic cataract.
        Arch Ophthalmol. 1999; 117: 284-285
        • Chiou S.H.
        • Chang C.J.
        • Chou C.K.
        • Hsu W.M.
        • Liu J.H.
        • Chiang C.H.
        Increased nitric oxide levels in aqueous humor of diabetic patients with neovascular glaucoma.
        Diabetes Care. 1999; 22: 861-862
        • Ookawara T.
        • Kawamura N.
        • Kitagawa Y.
        • Taniguchi N.
        Site-specific and random fragmentation of Cu,Zn-superoxide dismutase by glycation reaction. Implication of reactive oxygen species.
        J Biol Chem. 1992; 267: 18505-18510
        • Iafusco D.
        • Prisco F.
        • Romano M.R.
        • et al.
        Acute juvenile cataract in newly diagnosed type 1 diabetic patients: a description of six cases.
        Pediatr Diabetes. 2011; 12: 642-648