Arch Dis Child 1997;76:118-120 ( February )
Metabolic cataracts in newly diagnosed diabetes
Vipan Datta,a
Peter G F Swift,a
Geoffrey H A Woodruff,b
Roy F Harrisc
a Leicester Royal Infirmary, Leicester:
Children's Hospital, b Department of Ophthalmology, c Kings Mill Hospital, Sutton in Ashfield, Nottinghamshire
Correspondence to: Dr Vipan Datta,
Children's Hospital, Leicester Royal Infirmary, Leicester LE1 5WW.
Accepted 29 October 1996
The morphologically distinct diabetic or `metabolic' cataract
is rare in newly diagnosed insulin dependent diabetes. The cases described are of five adolescents (three girls, two boys) with newly
diagnosed insulin dependent diabetes who developed metabolic cataracts
close to the time of diagnosis (0-16 months). They all had a prolonged
duration of symptoms before diagnosis (4-24 months) and high glycated
haemoglobin levels at diagnosis (15-21%). The pathogenesis of
diabetic cataract is not well understood in humans. An attempt is made
to link clinical observations with evidence from experimental animal
models to understand the mechanism of cataract formation, with
particular reference to the aldose reductase pathway. It is recommended
that the lens and retina are examined at the onset of diabetes in all
children, especially those who have a prolonged duration of symptoms
before diagnosis and who report persistent blurred vision.
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Key messages
- Metabolic cataracts may occur in newly
diagnosed insulin dependent diabetes, but are rare
- Metabolic cataracts are more likely to occur in
children who have prolonged poor control or who present with prolonged
duration of symptoms before diagnosis
- The lens of the eye should be examined in all newly
diagnosed cases of insulin dependent diabetes, especially those with
blurred vision, to diagnose cataracts early
- If lens opacities are suspected, specialist
ophthalmological opinion should be sought and, if required, surgery
offered to improve the quality of life
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Keywords:
insulin dependent diabetes;
metabolic cataracts;
aldose reductase;
sorbitol pathway.
© 1997 by Archives of Disease in Childhood
