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Agarkar S, Chandrasekaran A, Panicker GJ, Raman R. Cataract surgery outcomes in children and adolescents with type 1 diabetes mellitus. J AAPOS 2024:103926. [PMID: 38719142 DOI: 10.1016/j.jaapos.2024.103926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/16/2024] [Accepted: 02/11/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE To report the outcomes of cataract surgery in children and adolescents with type 1 diabetes mellitus. METHODS The medical records of all pediatric patients (<18 years of age) with a diagnosis of type 1 diabetes mellitus who had undergone surgery for cataract between January 2000 and December 2019 at a tertiary care center were reviewed retrospectively. RESULTS A total of 27 eyes of 15 patients who met the inclusion criteria were included. Median age at cataract surgery was 13 (IQR, 9.5-16) years, and median follow-up was 3.8 (IQR, 1.25-7.2) years, with 11 eyes followed for more than 5 years. Visual acuity improved from a median preoperative value of 0.8 (IQR, 0.55-1.3) logMAR to 0.15 (IQR, 0-0.45) logMAR at final follow-up. Posterior capsular visual axis opacification in 40.7% and diabetic retinopathy in 14.8% were the common complications requiring additional intervention, including laser capsulotomy and panretinal photocoagulation, respectively. CONCLUSIONS Cataract surgery in children and adolescents with type 1 diabetes leads to improvement in visual acuity. Proliferative diabetic retinopathy can lead to poor visual outcomes in these children. Visual axis opacification occurs at similar rates with or without primary posterior capsulorhexis.
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Affiliation(s)
- Sumita Agarkar
- Pediatric Ophthalmology and Strabismus Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.
| | - Akila Chandrasekaran
- Pediatric Ophthalmology and Strabismus Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Gayathri J Panicker
- Pediatric Ophthalmology and Strabismus Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Department of Vitreoretinal services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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2
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Aihara K, Nakazawa Y, Takeda S, Hatsusaka N, Onouchi T, Hiramatsu N, Nagata M, Nagai N, Funakoshi-Tago M, Yamamoto N, Sasaki H. Aquaporins contribute to vacuoles formation in Nile grass type II diabetic rats. Med Mol Morphol 2023; 56:274-287. [PMID: 37493821 DOI: 10.1007/s00795-023-00365-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/09/2023] [Indexed: 07/27/2023]
Abstract
Regulation of ion and water microcirculation within the lens is tightly controlled through aquaporin channels and connexin junctions. However, cataracts can occur when the lens becomes cloudy. Various factors can induce cataracts, including diabetes which is a well-known cause. The most common phenotype of diabetic cataracts is a cortical and/or posterior subcapsular opacity. In addition to the three main types and two subtypes of cataracts, a vacuole formation is frequently observed; however, their origin remains unclear. In this study, we focused on the aquaporins and connexins involved in diabetes-induced cataracts and vacuoles in Nile grass type II diabetes. The results showed that the expression of aquaporin 0 and aquaporin 5 increased, and that of connexin 43 decreased in diabetic rat lenses. Additionally, aquaporin 0 and 5 were strongly localized in peripheral of vacuoles, suggesting that aquaporins are involved in vacuoles formation. Transillumination photography revealed large vacuoles at the tip of the Y-suture in the anterior capsule of the diabetic lens, and several small vacuoles were observed in the posterior capsule. Within the vacuoles, cytoplasmic degradation and aggregation of fibrous material were observed. Our findings suggest that aquaporins are potential candidate proteins for preventing vacuole formation.
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Affiliation(s)
- Kana Aihara
- Faculty of Pharmacy, Keio University, 1-5-30, Shibako-en, Minato-ku, Tokyo, 105-8512, Japan
| | - Yosuke Nakazawa
- Faculty of Pharmacy, Keio University, 1-5-30, Shibako-en, Minato-ku, Tokyo, 105-8512, Japan.
| | - Shun Takeda
- Department of Ophthalmology, Kanazawa Medical University, 1-1 Daigaku Uchinada-machi, Kahoku-gun, Kahoku, Ishikawa, 920-0293, Japan
| | - Natsuko Hatsusaka
- Department of Ophthalmology, Kanazawa Medical University, 1-1 Daigaku Uchinada-machi, Kahoku-gun, Kahoku, Ishikawa, 920-0293, Japan
| | - Takanori Onouchi
- Research Promotion Headquarters, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Noriko Hiramatsu
- Research Promotion Headquarters, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Mayumi Nagata
- Department of Ophthalmology, Dokkyo Medical University, Shimotsugagun, Tochigi, 321-0293, Japan
| | - Noriaki Nagai
- Faculty of Pharmacy, Kindai University, Higashi-Osaka, Osaka, 577-8502, Japan
| | - Megumi Funakoshi-Tago
- Faculty of Pharmacy, Keio University, 1-5-30, Shibako-en, Minato-ku, Tokyo, 105-8512, Japan
| | - Naoki Yamamoto
- Research Promotion Headquarters, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Hiroshi Sasaki
- Department of Ophthalmology, Kanazawa Medical University, 1-1 Daigaku Uchinada-machi, Kahoku-gun, Kahoku, Ishikawa, 920-0293, Japan.
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Alabdulwahhab KM. Senile Cataract in Patients with Diabetes with and Without Diabetic Retinopathy: A Community-Based Comparative Study. J Epidemiol Glob Health 2021; 12:56-63. [PMID: 34874549 PMCID: PMC8907352 DOI: 10.1007/s44197-021-00020-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/14/2021] [Indexed: 12/04/2022] Open
Abstract
Aim We compare the incidence rates of cataract in persons with diabetes with and without diabetic retinopathy in Saudi Arabia, for the first time. In addition, we explored the role of new factor, diabetes age of onset and several other known factors. Methods In a community-based cross-sectional study, 334 persons with diabetes type 2 were randomly selected from a diabetic register. Detailed history and comprehensive ophthalmic examination was done at an eye clinic. Body Mass Index, blood pressure and glycosylated hemoglobin were also recorded. Results In 668 eyes, cataract and diabetic retinopathy were present in 35.5% and 32.2%, respectively. Diabetic retinopathy, age, duration of diabetes and systolic BP were found to be independent risk factors for cataract. Whereas, gender, BMI, HbA1c use of insulin and diastolic BP have no significant association with cataract. Persons with cataract had significantly higher age of onset of diabetes. Most of the cataracts were cortical followed by PSC, while minority were nuclear. Conclusion DR is an independent risk factor of developing cataract in persons with diabetes. Others are age, duration of DM and hypertension. Age-of-onset of DM is a new factor we report it to be significantly associated with cataract.
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Essuman VA, Tagoe NN, Akpalu J, Essuman A, Sackey AH, Hayfron-Benjamin CF, Asare G, Abaidoo B, Amoah A, Ndanu T, Ofori-Adjei I, Barnes NA, Appiah-Thompson BL, Amoaku WM. Morbidity and Complications of Diabetes Mellitus in Children and Adolescents in Ghana: Protocol for a Longitudinal Study. JMIR Res Protoc 2021; 10:e21440. [PMID: 33404517 PMCID: PMC7817364 DOI: 10.2196/21440] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/21/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022] Open
Abstract
Background Diabetes is associated with premature morbidity and mortality from its many complications. There are limited data on the chronic complications of diabetes in children and adolescents in sub-Saharan Africa. Objective The study aims to determine the (1) burden and related factors of chronic systemic complications of diabetes, including diabetic and nondiabetic ocular conditions in children and adolescents, and (2) quality of life (QoL) of participants compared to healthy controls. This manuscript describes the study methodology. Methods Demographic information, medical history, anthropometric measurements, and laboratory characteristics were collected, and the participants were screened for microvascular and macrovascular complications as well as nondiabetic ocular disease. QoL questionnaires were administered to participants, their caregivers, and controls. Participants were followed up annually up to 3 years to determine the natural history of and trends in these conditions. SPSS Version 25.0 will be used for data analysis. Continuous and categorical data will be presented as mean (SD) and as percentages (%), respectively. t tests and analysis of variance will be used to compare means, and chi-square tests will be used to compare categorical data. Correlation, regression, and logistic regression analyses will be employed to establish linear associations and causal associations as appropriate. Relative risk and odds ratios will be used to estimate risk. QoL outcomes in Ghanaian children and adolescents with diabetes mellitus compared with caregivers and healthy controls will be assessed using the Pediatric Quality of Life inventory. Significance will be set at α=.05. Results Institutional approval from the Ethical and Protocol Review Committee of the University of Ghana Medical School was received on August 22, 2014 (Protocol Identification Number: MS-Et/M.12-P4.5/2013-2014). Funding for the project was received from the University of Ghana Research Fund (#UGRF/9/LMG-013/2015-2016) in March 2016. Patient recruitment, clinical examination, and data collection commenced in August 2016 and was completed in September 2019. A total of 58 children and adolescents with diabetes mellitus have been recruited. Blood samples were stored at –80 °C for analysis, which was completed at the end of July 2020. Data analysis is ongoing and will be completed by the end of December 2020. Investigators plan to submit the results for publication by the end of February 2021. Conclusions The prevalence, natural history, trends in diabetic complications and nondiabetic ocular disease, and QoL will be provided. Our data may inform policies and interventions to improve care given to children and adolescents with diabetes. International Registered Report Identifier (IRRID) DERR1-10.2196/21440
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Affiliation(s)
- Vera Adobea Essuman
- Ophthalmology Unit, Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | | | - Josephine Akpalu
- Department of Medicine and Tharapeutics, University of Ghana Medical School, Accra, Ghana
| | - Akye Essuman
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | - Adziri H Sackey
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - C F Hayfron-Benjamin
- Department of Physiology, University of Ghana Medical School, Accra, Ghana.,Department of Anaesthesia, Korle Bu Teaching Hospital, Accra, Ghana
| | - George Asare
- Chemical Pathology Unit, Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Benjamin Abaidoo
- Ophthalmology Unit, Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | - Agb Amoah
- Department of Medicine and Tharapeutics, University of Ghana Medical School, Accra, Ghana.,National Diabetes Management and Research Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Thomas Ndanu
- Department of Preventive and Community Dentistry, University of Ghana Dental School, Accra, Ghana
| | | | - N A Barnes
- Eye Department, Cape Coast Teaching Hospital, Accra, Ghana
| | | | - Winfried M Amoaku
- Ophthalmology and Visual Sciences (DCN), Faculty of Medicine and Health Sciences, School of Clinical Sciences, University Hospital, Nottingham, United Kingdom
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LncRNA MALAT1 Regulates miR-144-3p to Facilitate Epithelial-Mesenchymal Transition of Lens Epithelial Cells via the ROS/NRF2/Notch1/Snail Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8184314. [PMID: 33274006 PMCID: PMC7683160 DOI: 10.1155/2020/8184314] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/10/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022]
Abstract
Diabetic cataract is a common complication of diabetes. The epithelial-mesenchymal transition (EMT) of lens epithelial cells (LECs) is a key event in the development of diabetic cataracts. Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) has been reported to be highly expressed in different tissues of diabetic patients. This study is aimed at investigating the function and mechanism of MALAT1 in the regulation of EMT in human LECs under high glucose conditions. MALAT1, α-smooth muscle actin (α-SMA), fibronectin (FN), and nuclear factor erythroid-derived 2-like 2 (NRF2) were highly expressed in the LECs of diabetic cataract patients and in the human LECs under high glucose conditions; meanwhile, the decreased expressions of E-cadherin and zonula occludens 1 (ZO-1) were detected. Knockdown of MALAT1 could significantly reduce ROS, prevent EMT, arrest S phase cell cycle, and suppress the expression of total NRF2 and its nucleus translocation in LECs. Furthermore, after NRF2 was knocked down, total NRF2, α-SMA, and FN in cells, and NRF2, Notch intracellular domain (NICD), and Snail were decreased in the nucleus. Using bioinformatics methods, we predicted that MALAT1 and NRF2 shared the same microRNA-144-3p (miR-144-3p) combining site. Luciferase reporter coupled with qRT-PCR assays revealed that miR-144-3p was a target of MALAT1, which was confirmed to downregulate miR-144-3p in the LECs. In addition, after transfection of miR-144-3p mimics or inhibitor, western blot assay demonstrated that miR-144-3p negatively regulated the expression of total NRF2, α-SMA, and FN in cells, and NRF2, NICD, and Snail in the nucleus without affecting Kelch-like ECH-associated protein 1 (KEAP1). Finally, we confirmed that transfection of shMALAT1 inhibited NRF2 expression, and its mediated EMT could be rescued by miR-144-3p inhibitor; transfection of pcDNA3.1-MALAT1 promoted NRF2 expression, and its mediated EMT could be reversed by miR-144-3p inhibitor. In summary, we demonstrate that MALAT1 regulates miR-144-3p to facilitate EMT of LECs via the ROS/NRF2/Notch1/Snail pathway.
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Effect of Berberine on Glycation, Aldose Reductase Activity, and Oxidative Stress in the Lenses of Streptozotocin-Induced Diabetic Rats In Vivo-A Preliminary Study. Int J Mol Sci 2020; 21:ijms21124278. [PMID: 32560082 PMCID: PMC7349706 DOI: 10.3390/ijms21124278] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus affects the eye lens, leading to cataract formation by glycation, osmotic stress, and oxidative stress. Berberine, an isoquinoline alkaloid, is a natural compound that has been reported to counteract all these pathological processes in various tissues and organs. The goal of this study was to evaluate whether berberine administered at a dose of 50 mg/kg by oral gavage for 28 days to rats with streptozotocin-induced diabetes reveals such effects on the biochemical parameters in the lenses. For this purpose, the following lenticular parameters were studied: concentrations of soluble protein, non-protein sulfhydryl groups (NPSH), advanced oxidation protein products (AOPP), advanced glycation end-products (AGEs), thiobarbituric acid reactive substances (TBARS), and activities of aldose reductase (AR), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). Diabetes induced unfavorable changes in the majority of the examined parameters. The administration of berberine resulted in an increased soluble protein level, decreased activity of AR, and lowered AOPP and AGEs levels. The results suggest that berberine administered orally positively affects the lenses of diabetic rats, and should be further examined with regard to its anticataract potential.
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Cook E, Stratton E, Thornton MD. Acute Cataract Development in a Pediatric Patient With Type 1 Diabetes. J Emerg Med 2020; 58:e207-e209. [PMID: 32245686 DOI: 10.1016/j.jemermed.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/31/2020] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND 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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Affiliation(s)
- Elana Cook
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Emily Stratton
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Matthew D Thornton
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY
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8
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Beck DER, Burgess FR, Schmoll CLL. Bilateral cataracts as the presenting feature of type 1 diabetes in an 11-year-old girl. BMJ Case Rep 2018; 2018:bcr-2018-225644. [PMID: 30115719 PMCID: PMC6101330 DOI: 10.1136/bcr-2018-225644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 11/03/2022] Open
Abstract
Paediatric cataracts can present a diagnostic dilemma to ophthalmologists. Next-generation DNA sequencing (NGS) has been promoted as a tool to expedite the diagnosis of an underlying cause in such cases.1 The authors present an unusual case of bilateral cataracts in an 11-year-old girl as the first presenting feature of new type 1 diabetes mellitus. Prompt diagnosis and subsequent management of this potentially life-threatening condition were achieved through careful history taking and targeted biochemical testing. The authors feel this case highlights the significance of simple measures such as thorough history taking in the assessment of paediatric cataracts. It is important that these skills are not lost through the availability of clinical tools such as NGS.
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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. [PMID: 29755521 PMCID: PMC5883981 DOI: 10.1155/2018/6763586] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/28/2018] [Indexed: 12/19/2022] Open
Abstract
Cataract is a rare manifestation of ocular complication at an early phase of T1DM in the pediatric population. The pathophysiological mechanism of early diabetic cataract has not been fully understood; however, there are many theories about the possible etiology including osmotic damage, polyol pathway, and oxidative stress. The prevalence of early diabetic cataract in the population varies between 0.7 and 3.4% of children and adolescents with T1DM. The occurrence of diabetic cataract in most pediatric patients is the first sign of T1DM or occurs within 6 months of diagnosis of T1DM. Today, there are many experimental therapies for the treatment of diabetic cataract, but cataract surgery continues to be a gold standard in the treatment of diabetic cataract. Since the cataract is the leading cause of visual impairment in patients with T1DM, diabetic cataract requires an initial screening as well as continuous surveillance as a measure of prevention and this should be included in the guidelines of pediatric diabetes societies.
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Affiliation(s)
- Marko Šimunović
- Department of Pediatrics, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Martina Paradžik
- Department of Ophthalmology, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Roko Škrabić
- School of Medicine, University of Split, Šoltanska 2, Split, Croatia
| | - Ivana Unić
- Department of Pediatrics, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Kajo Bućan
- Department of Ophthalmology, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Veselin Škrabić
- Department of Pediatrics, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
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Tekin K, Inanc M, Kurnaz E, Bayramoglu E, Aydemir E, Koc M, Aycan Z. Objective Evaluation of Corneal and Lens Clarity in Children With Type 1 Diabetes Mellitus. Am J Ophthalmol 2017; 179:190-197. [PMID: 28528120 DOI: 10.1016/j.ajo.2017.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/07/2017] [Accepted: 05/10/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate whether abnormal glucose metabolism and duration of diabetes mellitus (DM) affected the corneal and lens clarity in children with well-controlled type 1 DM and to compare the results obtained with those in healthy children. DESIGN Cross-sectional prospective study. METHODS This multicenter study enrolled 56 patients with DM and 51 control subjects. The duration of DM and the glycosylated hemoglobin (HbA1c) levels of the patients in the DM group were recorded. The Pentacam HR imaging system was used for corneal densitometry (12-mm corneal diameter) measurements. Furthermore, the lens densitometry and lens thickness (LT) measurements were performed after dilation of the pupils, using the same Pentacam HR device. RESULTS The corneal densitometry values were similar in all concentric zones and layers in both groups (P > .05, for all). The mean values of the average and maximum lens densitometry measurements of the 2 groups, as well as the mean LT values, were statistically significantly different (P = .021, P = .011, and P < .001, respectively). There were statistically significant correlations between the lens densitometry values and the duration of DM (P < .05, for all). Conversely, no statistically significant relationship was found between the lens densitometry values and HbA1c levels (r = 0.743; P = .084). CONCLUSIONS The children with type 1 DM had decreased lens clarity and increased LT, even in cases of well-controlled DM, without DR. It is reasonable to think that these changes might have been caused by the type 1 DM.
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Affiliation(s)
- Kemal Tekin
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey.
| | - Merve Inanc
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Erdal Kurnaz
- Department of Pediatric Endocrinology and Metabolism, Dr Sami Ulus Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Elvan Bayramoglu
- Department of Pediatric Endocrinology and Metabolism, Dr Sami Ulus Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Emre Aydemir
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Mustafa Koc
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Zehra Aycan
- Department of Pediatric Endocrinology and Metabolism, Dr Sami Ulus Children's Health and Disease Training and Research Hospital, Ankara, Turkey
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Khan A, Petropoulos IN, Ponirakis G, Malik RA. Visual complications in diabetes mellitus: beyond retinopathy. Diabet Med 2017; 34:478-484. [PMID: 27917530 DOI: 10.1111/dme.13296] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
Abstract
Diabetic retinopathy is the most common cause of vision loss in people with diabetes mellitus; however, other causes of visual impairment/loss include other retinal and non-retinal visual problems, including glaucoma, age-related macular degeneration, non-arteritic anterior ischaemic optic neuropathy and cataracts. Additionally, when a person with diabetes complains of visual disturbance despite a visual acuity of 6/6, abnormalities in refraction, contrast sensitivity, straylight and amplitude of accommodation should be considered. We review and highlight these visual problems for physicians who manage people with diabetes to ensure timely referral and treatment to limit visual disability, which can have a significant impact on daily living, especially for those participating in sports and driving.
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Affiliation(s)
- A Khan
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | | | - R A Malik
- Weill Cornell Medicine-Qatar, Doha, Qatar
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García García E, García Robles E. Cataract: A forgotten early complication of diabetes in children and adolescents. ACTA ACUST UNITED AC 2017; 64:58-59. [PMID: 28440772 DOI: 10.1016/j.endinu.2016.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Emilio García García
- Unidad de Endocrinología Pediátrica, Hospital Virgen del Rocío, Sevilla, España.
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Wasserman H, Hufnagel RB, Miraldi UV, Zhang K, Valencia CA, Leslie ND, Crimmins NA. Bilateral cataracts in a 6-yr-old with new onset diabetes: a novel presentation of a known INS gene mutation. Pediatr Diabetes 2016; 17:535-539. [PMID: 26530398 PMCID: PMC4854816 DOI: 10.1111/pedi.12335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 01/12/2023] Open
Abstract
The prevalence of diabetes-related cataracts during childhood is less than 1%. When cataracts occur, it is often in adolescent females with prolonged symptoms and significant hyperglycemia. Cataracts are not a classic feature of monogenic diabetes. We report a case of a 6-yr-old, previously healthy Caucasian male, who presented with bilateral acquired cataracts and was subsequently diagnosed with new onset diabetes. Additional symptoms at presentation included a several year history of polyuria and polydipsia, mild hepatomegaly, and short stature. Pertinent negatives include acanthosis nigricans, lipoatrophy, deafness, muscle weakness, or neuropathy. HbA1c was significantly elevated at diagnosis (>14%, 129.5 mmol/mol) without evidence of ketosis. Autoantibody testing was negative. Features of Mauriac syndrome (short stature, hepatomegaly) as well as acquired cataracts indicated long-standing hyperglycemia with sufficient insulin production to prevent ketone production and development of diabetic ketoacidosis. Whole exome sequencing was conducted and a de novo heterozygous mutation in the INS gene (c.94G>A; p.Gly32Ser) was identified. INS gene mutations are common causes of permanent neonatal diabetes but rare causes of antibody-negative diabetes in children. Importantly, INS gene mutations have not been previously associated with acquired cataracts. Knowledge of a monogenic cause of diabetes allows clinicians to tailor counseling and screening of diabetes-related comorbidities. In summary, this case highlights the need to consider testing for monogenic diabetes, specifically INS gene mutations, in pediatric patients with antibody-negative diabetes, especially if complications of prolonged hyperglycemia are present at diagnosis.
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Affiliation(s)
- H Wasserman
- Cincinnati Children’s Hospital Medical Center Division of Endocrinology 3333 Burnet Ave MLC 7012, Cincinnati, Ohio 45229
| | - RB Hufnagel
- Cincinnati Children’s Hospital Medical Center Division of Human Genetics 3333 Burnet Ave MLC 4006, Cincinnati, Ohio 45229
| | - Utz V Miraldi
- Cincinnati Children’s Hospital Medical Center Department of Ophthalmology 3333 Burnet Ave MLC 4008, Cincinnati, Ohio 45229
| | - K Zhang
- Cincinnati Children’s Hospital Medical Center Division of Human Genetics 3333 Burnet Ave MLC 4006, Cincinnati, Ohio 45229
| | - CA Valencia
- Cincinnati Children’s Hospital Medical Center Division of Human Genetics 3333 Burnet Ave MLC 4006, Cincinnati, Ohio 45229
| | - ND Leslie
- Cincinnati Children’s Hospital Medical Center Division of Human Genetics 3333 Burnet Ave MLC 4006, Cincinnati, Ohio 45229
| | - NA Crimmins
- Cincinnati Children’s Hospital Medical Center Division of Endocrinology 3333 Burnet Ave MLC 7012, Cincinnati, Ohio 45229
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Wang Y, Qin S, Pen G, Chen D, Han C, Miao C, Lu B, Su C, Feng S, Li W, Han J, Cho NC, Si Y. Original Research: Potential ocular protection and dynamic observation of Polygonatum sibiricum polysaccharide against streptozocin-induced diabetic rats' model. Exp Biol Med (Maywood) 2016; 242:92-101. [PMID: 27510582 DOI: 10.1177/1535370216663866] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/24/2016] [Indexed: 01/01/2023] Open
Abstract
Ocular complications associated with diabetes mellitus are progressive and becoming one of the most important causes of morbidity worldwide. The purpose of the study is to evaluate the protective effect of Polygonatum sibiricum polysaccharide, an important component of Polygonatum sibiricum, on ocular complications in streptozotocin-induced diabetes mellitus rats. Sprague Dawley rats were made diabetic with streptozotocin(60 mg/kg, i.v.) and then the rats were treated with Polygonatum sibiricum polysaccharide 200, 400 and 800 mg/kg.d by gavage for 12 weeks. Biochemical analysis indicated that Polygonatum sibiricum polysaccharide lowered the levels of fasting blood glucose and glycated hemoglobin in blood and elevated the levels of insulin and C-peptide in plasma of diabetes mellitus rats in a dose-dependent manner. Physical measurements revealed that Polygonatum sibiricum polysaccharide improved clinical symptoms of polydipsia, polyphagia, polyuria and weight loss in diabetes mellitus rats. The content of malondialdehyde and activity of superoxide dismutase in plasma were determined, and the data showed Polygonatum sibiricum polysaccharide suppressed oxidative stress reaction. Lens opacification was observed using slit lamp illumination, and the data showed Polygonatum sibiricum polysaccharide delayed cataract progression in a dose-dependent manner. Electroretinogram showed Polygonatum sibiricum polysaccharide treatment reversed the decrease of electroretinogram b and OPs2 waves' amplitudes. Flash-visual evoked potential test indicated that the peak time of P2 wave was prolonged, and the amplitude of N2-P2 was lowered in diabetes mellitus group, and Polygonatum sibiricum polysaccharide suppressed these changes. Fundus fluorescein angiography showed Polygonatum sibiricum polysaccharide alleviated the retinal vasculopathy in a dose-dependent manner. In conclusion, these results suggest that the administration of Polygonatum sibiricum polysaccharide slows the progression of diabetic retinopathy and cataract through alleviating hyperglycemia and reducing oxidative stress in streptozotocin-induced diabetes mellitus rats.
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Affiliation(s)
- Yi Wang
- Department of Ophthalmology, Chonbuk National University, Jeollabuk-do 561-756, Republic of Korea (past position).,Department of Ophthalmology, Affiliated Hospital of Taishan Medical University, Taian 271000, China
| | - Shucun Qin
- Key Laboratory of Atherosclerosis in Universities of Shandong and Institute of Atherosclerosis, Taishan Medical University, Taian 271000, China
| | - Guoqing Pen
- Department of Ophthalmology, Affiliated Hospital of Taishan Medical University, Taian 271000, China
| | - Di Chen
- Department of Ophthalmology, Affiliated Hospital of Taishan Medical University, Taian 271000, China
| | - Chao Han
- Department of Ophthalmology, Affiliated Hospital of Taishan Medical University, Taian 271000, China
| | - Chunrun Miao
- Department of Ophthalmology, Affiliated Hospital of Taishan Medical University, Taian 271000, China
| | - Baojin Lu
- Department of Ophthalmology, Affiliated Hospital of Taishan Medical University, Taian 271000, China
| | - Chao Su
- Department of Ophthalmology, Affiliated Hospital of Taishan Medical University, Taian 271000, China
| | - Shanlong Feng
- Department of Ophthalmology, Affiliated Hospital of Taishan Medical University, Taian 271000, China
| | - Wen Li
- Department of Ophthalmology, Affiliated Hospital of Taishan Medical University, Taian 271000, China
| | - Jingjing Han
- Department of Ophthalmology, Affiliated Hospital of Taishan Medical University, Taian 271000, China
| | - Nam C Cho
- Department of Ophthalmology, Chonbuk National University, Jeollabuk-do 561-756, Republic of Korea (past position)
| | - Yanhong Si
- Key Laboratory of Atherosclerosis in Universities of Shandong and Institute of Atherosclerosis, Taishan Medical University, Taian 271000, China
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15
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Sayin N, Kara N, Pekel G. Ocular complications of diabetes mellitus. World J Diabetes 2015; 6:92-108. [PMID: 25685281 PMCID: PMC4317321 DOI: 10.4239/wjd.v6.i1.92] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/06/2014] [Accepted: 12/10/2014] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus (DM) is a important health problem that induces ernestful complications and it causes significant morbidity owing to specific microvascular complications such as, retinopathy, nephropathy and neuropathy, and macrovascular complications such as, ischaemic heart disease, and peripheral vasculopathy. It can affect children, young people and adults and is becoming more common. Ocular complications associated with DM are progressive and rapidly becoming the world’s most significant cause of morbidity and are preventable with early detection and timely treatment. This review provides an overview of five main ocular complications associated with DM, diabetic retinopathy and papillopathy, cataract, glaucoma, and ocular surface diseases.
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Modrzejewska M, Grzesiak W, Zaborski D, Wilk G, Modrzejewska A. Relationship between Initial Lens Transparency and Ocular Circulation in Adolescents with Type-1 Diabetes Mellitus, Unstable Glycaemia and Lipid Parameters. Pol J Radiol 2014; 79:472-8. [PMID: 25535511 PMCID: PMC4273849 DOI: 10.12659/pjr.890852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/07/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the relationships between lens opacity, vascular and lipid factors and retrobulbar blood flow parameters in type-1 diabetic (DM) adolescents. MATERIAL/METHODS Glycated haemoglobin (HbA1c), total cholesterol (TCH), high- and low-density cholesterol, triglycerides (TG) and apolipoprotein B (ApoB) were determined in 28 patients with (DM-1) and without (DM-0) lens opacity and 18 controls. In the ophthalmic, central retinal (CRA) and temporal posterior ciliary (TPCA) arteries, the systolic (PSV), end-diastolic and mean blood flow velocities as well as pulsatility and resistance (RI) indices were measured. RESULTS Ten (35.71%) diabetic patients exhibited lens opacification. Higher TG and TCH levels in the DM-1 group and HbA1c level in the DM-0 and DM-1 groups were observed (P≤0.05). Diabetic patients had lower PSV and higher RI within CRA and TPCA (P≤0.05). Significant correlations between biochemical and blood flow parameters were found. CONCLUSIONS Glycaemic and lipid factors may play a vasoconstrictive role in retrobulbar endotheliopathy.
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Affiliation(s)
- Monika Modrzejewska
- Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland
| | - Wilhelm Grzesiak
- Laboratory of Biostatistics, West Pomeranian University of Technology, Szczecin, Poland
| | - Daniel Zaborski
- Laboratory of Biostatistics, West Pomeranian University of Technology, Szczecin, Poland
| | - Grażyna Wilk
- Department of General and Dental Diagnostic Imaging, Pomeranian Medical University, Szczecin, Poland
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17
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Manaviat MR, Oveisi N, Zare-Bidoki A. Accelerated bilateral cataract formation as a first manifestation of diabetes mellitus. Prague Med Rep 2014; 114:258-62. [PMID: 24485343 DOI: 10.14712/23362936.2014.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
There is a proved relationship between diabetes mellitus and the cataract formation. The incidence of this is usually related to the duration of diabetes. In this manuscript we report a 15 years old female presented to the emergency room with a 4 hour history of rapid bilateral diminished vision, initially diagnosed with idiopathic cataracts, but after more laboratory evaluations revealed new-onset type 1 diabetes mellitus without ketosis.
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Affiliation(s)
- M R Manaviat
- Department of Ophthalmology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - N Oveisi
- Department of Ophthalmology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - A Zare-Bidoki
- Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
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18
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Palsamy P, Bidasee KR, Ayaki M, Augusteyn RC, Chan JY, Shinohara T. Methylglyoxal induces endoplasmic reticulum stress and DNA demethylation in the Keap1 promoter of human lens epithelial cells and age-related cataracts. Free Radic Biol Med 2014; 72:134-48. [PMID: 24746615 PMCID: PMC4410980 DOI: 10.1016/j.freeradbiomed.2014.04.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/03/2014] [Accepted: 04/08/2014] [Indexed: 01/03/2023]
Abstract
Age-related cataracts are a leading cause of blindness. Previously, we have demonstrated the association of the unfolded protein response with various cataractogenic stressors. However, DNA methylation alterations leading to suppression of lenticular antioxidant protection remains unclear. Here, we report the methylglyoxal-mediated sequential events responsible for Keap1 promoter DNA demethylation in human lens epithelial cells, because Keap1 is a negative regulatory protein that regulates the Nrf2 antioxidant protein. Methylglyoxal induces endoplasmic reticulum stress and activates the unfolded protein response leading to overproduction of reactive oxygen species before human lens epithelial cell death. Methylglyoxal also suppresses Nrf2 and DNA methyltransferases but activates the DNA demethylation pathway enzyme TET1. Bisulfite genomic DNA sequencing confirms the methylglyoxal-mediated Keap1 promoter DNA demethylation leading to overexpression of Keap1 mRNA and protein. Similarly, bisulfite genomic DNA sequencing shows that human clear lenses (n = 15) slowly lose 5-methylcytosine in the Keap1 promoter throughout life, at a rate of 1% per year. By contrast, diabetic cataractous lenses (n = 21) lose an average of 90% of the 5-methylcytosine regardless of age. Overexpressed Keap1 protein is responsible for decreasing Nrf2 by proteasomal degradation, thereby suppressing Nrf2-dependent stress protection. This study demonstrates for the first time the associations of unfolded protein response activation, Nrf2-dependent antioxidant system failure, and loss of Keap1 promoter methylation because of altered active and passive DNA demethylation pathway enzymes in human lens epithelial cells by methylglyoxal. As an outcome, the cellular redox balance is altered toward lens oxidation and cataract formation.
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Affiliation(s)
- Periyasamy Palsamy
- Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Keshore R Bidasee
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Masahiko Ayaki
- Department of Ophthalmology, Keio University, Tokyo 1698582, Japan
| | - Robert C Augusteyn
- Vision Cooperative Research Centre, Brien Holden Vision Institute, Sydney 2052, Australia; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Jefferson Y Chan
- Department of Laboratory Medicine and Pathology, University of California at Irvine, Irvine, CA 92697, USA
| | - Toshimichi Shinohara
- Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA.
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20
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Goturu A, Jain N, Lewis I. Bilateral cataracts and insulin oedema in a child with type 1 diabetes mellitus. BMJ Case Rep 2013; 2013:bcr-2012-008235. [PMID: 23378550 DOI: 10.1136/bcr-2012-008235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We describe a teenage type 1 diabetic girl with painless pedal oedema and bilateral cataracts. She developed oedema after commencement of intensive insulin therapy and achievement of excellent glycaemic control. In addition, she was also found to have bilateral subcapsular cataracts. The oedema subsided spontaneously and she underwent surgical treatment for the cataracts. Insulin oedema is a rare complication of insulin therapy. To our knowledge, co-occurrence of these two complications in a young diabetic patient has not been described before in the English language medical literature.
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Affiliation(s)
- Aruna Goturu
- Department of Paediatrics, East Surrey Hospital, Redhill, UK.
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21
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Iafusco D, Prisco F, Romano MR, Dell'omo R, Libondi T, Costagliola C. Acute juvenile cataract in newly diagnosed type 1 diabetic patients: a description of six cases. Pediatr Diabetes 2011; 12:642-8. [PMID: 21477105 DOI: 10.1111/j.1399-5448.2010.00749.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cataract represents one of the most frequent eye complications in type 1 and type 2 patients; contrarily, acute cataract in young diabetic patients occurs very rarely. The aim of this study was to describe six cases of acute cataract in adolescents at the onset of type 1 diabetes. Eight hundred and twenty-six patients with type 1 diabetes were retrospectively studied. A multivariate analysis was applied to verify the weight of the following laboratory findings taken on admission (independent variables): glycemia, glycated hemoglobin (HbA1c), pH, base excess (BE),and on the occurrence of cataract (dependent variable). Six patients (0.7%) presented with acute lens opacities. Cataract development was significantly correlated with HbA1c and glycemia. The relative risk increases about twice for each percentage point from 12.8 to 14.1% of HbA1c; glycemic blood levels represent a moderate risk factor for cataractogenesis. Ketoacidosis and BE were not significantly correlated.
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Affiliation(s)
- Dario Iafusco
- Department of Pediatrics, Second University of Naples, Naples, Italy
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22
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Bilateral Early Cataracts in Type 1 Diabetes. Med J Armed Forces India 2011; 65:71-2. [PMID: 27408198 DOI: 10.1016/s0377-1237(09)80063-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 07/24/2008] [Indexed: 11/21/2022] Open
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Abstract
A 13-year-old girl presented with the gradual onset of bilateral visual changes. She was initially diagnosed with idiopathic cataracts, but a medical evaluation revealed new-onset type 1 diabetes mellitus with ketosis. The patient was hospitalized and started on a regimen of insulin before discharge and eventual surgical correction of her cataracts. Cataracts are an uncommon initial manifestation of new-onset type 1 diabetes, occasionally in the absence of other more classic symptoms of diabetes. Pediatric patients presenting with bilateral cataracts should be evaluated for a underlying etiology of their cataracts before being referred for surgical correction.
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Skrabic V, Ivanisevic M, Stanic R, Unic I, Bucan K, Galetovic D. Acute bilateral cataract with phacomorphic glaucoma in a girl with newly diagnosed type 1 diabetes mellitus. J Pediatr Ophthalmol Strabismus 2010; 47 Online:e1-3. [PMID: 21158359 DOI: 10.3928/01913913-20100719-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 05/06/2010] [Indexed: 11/20/2022]
Abstract
The authors present a rare case of acute bilateral cataract with phacomorphic glaucoma in a girl with newly diagnosed type 1 diabetes mellitus without a known history of ocular problems. Within 3 months after the diagnosis of diabetes mellitus, she presented with high intraocular pressure. Her visual acuity was limited to hand motions. The patient required immediate surgical intervention. Postoperatively, the intraocular pressure normalized and bilateral visual acuity was 6/6.
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Affiliation(s)
- Veselin Skrabic
- Department of Pediatrics, Split University Hospital Centre, Split, Croatia.
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Abstract
Diabetes mellitus is associated with a 5-fold higher prevalence of cataracts, which remains a major cause of blindness in the world. Typical diabetic cataracts contain cortical and/or posterior subcapsular opacities. Adult onset diabetic cataracts also often contain nuclear opacities. Mechanisms of diabetic cataractogenesis have been studied in less detail than those of other diabetic complications. Both animal and human studies support important contribution of increased aldose reductase activity. Surgical extraction is the only cure of diabetic cataract today. An improved understanding of pathogenetic mechanisms, together with finding effective therapeutic agents, remain highest priority for diabetic cataract-related research and pharmaceutical development.
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Affiliation(s)
- Irina G Obrosova
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70808, USA.
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27
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Esteves JF, Dal Pizzol MM, Sccoco CA, Roggia MF, Milano SB, Guarienti JAA, Rodrigues TC, Canani LH. Cataract and type 1 diabetes mellitus. Diabetes Res Clin Pract 2008; 82:324-8. [PMID: 18926582 DOI: 10.1016/j.diabres.2008.08.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 08/11/2008] [Accepted: 08/27/2008] [Indexed: 12/16/2022]
Abstract
AIMS To evaluate the prevalence of cataract and the possible factors associated with cataract in young type 1 diabetes mellitus (DM). METHODS 293 patients were evaluated. The association of cataract with diabetic retinopathy (DR), retinal laser treatment, hypertension, body mass index, peripheral neuropathy, lipid profile, glycemic control, serum creatinine and albuminuria was evaluated. RESULTS Cataract was present in 19.8% (n=58) of the sample. Patients with cataracts were older, had a higher frequency of history of retina photocoagulation treatment, higher serum creatinine values and higher prevalence of arterial hypertension. There was a progressive increase in cataract frequency according to the number of risk factors, starting to rise with two or more. In logistic regression model cataract was associated with mild/moderate DR (odd ratio (OR) 4.28 95% CI 1.63-11.29), severe DR (OR 4.07 95% CI 1.63-10.23) and macroalbuminuria (OR 2.34 95% CI 1.06-5.16). CONCLUSION These data indicate a high prevalence of cataract in subjects with type 1 DM attending a general hospital in Southern Brazil and suggest that the more severe the disease process the greater is the risk of having this diabetic complication. Cataract should be suspected in young patients with two or more risk factors.
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Abstract
Steroid-induced posterior subcapsular cataracts (PSCs) exhibit three main distinctive characteristics: (i) association only with steroids possessing glucocorticoid activity, (ii) involvement of aberrant migrating lens epithelial cells, and (iii) a central posterior location. The first characteristic suggests a key role for glucocorticoid receptor activation and subsequent changes to the transcription of specific genes. Glucocorticoid receptor activation is associated in many cell types with proliferation, suppressed differentiation, a reduced susceptibility to apoptosis, altered transmembrane transport, and enhancement of reactive oxygen species activity. Glucocorticoids may be capable of inducing changes to the transcription of genes in lens epithelial cells that are related to many of these cellular processes. This review examines the various mechanisms that have been proposed to account for the development of PSC in the context of recent DNA array studies. Additionally, given that the glucocorticoid receptor can also engender wide-ranging indirect activities, glucocorticoids could also indirectly affect the lens through the responses of other cells within the ocular compartment and/or through effects on cells at more remote locations. These indirect mechanisms, which, for example, could be mediated through alterations to the intraocular levels of growth factors that normally orchestrate lens development and maintain lens homeostasis, are also discussed. Although the mechanism of steroid cataract induction remains unknown, glucocorticoid-induced gene transcription events in lens epithelial cells, and also other intraocular or systemic cells, likely interact to generate steroid cataracts. Finally, although evidence for glucocorticoid-protein adduct formation in the lens is inconclusive, the generation of such adducts cannot yet be discounted as a contributing factor and must necessarily be retained in discussions of the etiology of steroid cataract.
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29
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Costagliola C, Dell'Omo R, Prisco F, Iafusco D, Landolfo F, Parmeggiani F. Bilateral isolated acute cataracts in three newly diagnosed insulin dependent diabetes mellitus young patients. Diabetes Res Clin Pract 2007; 76:313-5. [PMID: 16997414 DOI: 10.1016/j.diabres.2006.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 08/21/2006] [Indexed: 12/01/2022]
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30
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Tsai CY, Tung TH, Woung LC, Liu JH, Lee FL, Shih HC, Chen SJ, Chou P. Population-based study of cataract surgery among patients with type 2 diabetes in Kinmen, Taiwan. CANADIAN JOURNAL OF OPHTHALMOLOGY 2007; 42:262-267. [DOI: 10.3129/can.j.ophthalmol.i07-013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2024]
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Cataract associated with type-1 diabetes mellitus in the pediatric population. J AAPOS 2007; 11:162-5. [PMID: 17306995 DOI: 10.1016/j.jaapos.2005.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Accepted: 10/12/2005] [Indexed: 01/29/2023]
Abstract
PURPOSE To report 14 cases (28 eyes) of cataract associated with type-1 diabetes mellitus in young children and adolescents. METHODS Retrospective review of the medical records of 14 patients from seven institutions. All patients under the age of 18 years who met the inclusion criteria of type-1 diabetes mellitus and cataract were included. RESULTS Mean age at the time of diabetes diagnosis was 9.8 years (range, 0.5-14 years), and mean age at cataract diagnosis was 11.7 years (range, 5-16 years). Two patients presented with cataracts one month before the diagnosis of diabetes; seven after the diagnosis of diabetes; and in five patients the cataract was found at the time the diabetes was diagnosed by the pediatrician. Nineteen out of 23 operated eyes had a best corrected post operative visual acuity of 20/40 or better. Two patients (4 eyes) developed diabetic retinopathy postoperatively. CONCLUSIONS Although cataract formation in type-1 diabetes is rare, it is treatable and potentially sight-saving in young children and adolescents.
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Suzuki Y, Atsumi Y, Matsuoka K, Suzuki Y, Nishimaki K, Ohta S, Suzuki Y, Taniyama M, Suzuki Y, Muramatsu T, Suzuki Y. Acute metabolic cataract as a first manifestation of diabetes mellitus in a 12-year-old girl. Diabetologia 2004; 47:592-3. [PMID: 15112638 DOI: 10.1007/s00125-004-1333-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee DM, Hoffman WH, Carl GF, Khichi M, Cornwell PE. Lipid peroxidation and antioxidant vitamins prior to, during, and after correction of diabetic ketoacidosis. J Diabetes Complications 2002; 16:294-300. [PMID: 12126788 DOI: 10.1016/s1056-8727(01)00215-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Oxidative stress plays an important role in the chronic complications of insulin-dependent diabetes mellitus (IDDM). Hyperketonemia, as well as hyperglycemia, is involved in the generation of oxygen-free radicals. We have studied the degree of oxidative stress in six patients before, during, and after correction of diabetic ketoacidosis (DKA) by determining the plasma ratios of C20 and C18 fatty acids to C16 fatty acids in the cholesteryl esters of the lipoproteins as well as in the plasma concentrations of the antioxidant vitamins A, C, and E. Lipid peroxidation was slightly increased prior to treatment. However, the C20/C16 ratio at 120 h was significantly decreased in comparison to the ratio at pretreatment (P<.025), at 6-8 h (P<.005), and at 24 h (P<.025). The C18/16 ratio at 120 h was also decreased in comparison to the ratio at 6-8 h (P<.025), indicating an increase in lipid peroxidation after correction of DKA. Vitamin A was below normal at pretreatment and was increased at 120 h (P<.05). Vitamin C was normal at pretreatment and decreased to low normal at 24 h (P<.005). Vitamin E was normal at pretreatment and decreased to below normal at 24 and 120 h, although the changes were not statistically significant. These data demonstrate that there is an increase in lipid peroxidation after the correction of DKA and therefore support the position that administering antioxidant vitamins during the treatment of DKA could be beneficial in minimizing oxidative stress and possibly both the acute and chronic complications of IDDM.
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Affiliation(s)
- Diana M Lee
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Lipid and Lipoprotein Laboratory, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
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Al-Till M, Jarrah NS, Ajlouni KM. Ophthalmologic findings in fifteen patients with Wolfram syndrome. Eur J Ophthalmol 2002; 12:84-8. [PMID: 12022290 DOI: 10.1177/112067210201200202] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To look for ophthalmologic abnormalities in 15 patients with Wolfram syndrome, also known as DIDMOAD syndrome (diabetes insipidus, diabetes mellitus, optic atrophy and deafness). METHODS Fifteen patients from four inbred families diagnosed as having Wolfram syndrome at the National Center for Diabetes, Endocrinology and Genetics, in Amman, Jordan, were evaluated ophthalmologically. Their examination included best-corrected visual acuity, color vision testing, pupillary light reflexes, slit-lamp biomicroscopy and fundus examination. Fundus fluorescein angiography was done in all patients. RESULTS The prevalence of optic atrophy was (93.3%), colordefect (92.9%), cataract (66.6%), pigmentary retinopathy (30%) and diabetic retinopathy (20%). Abnormal pupillary light reflexes and nystagmus were also reported. CONCLUSIONS Although ourgroup of patients was genetically heterogeneous, the ophthalmic findings are consistent with those reported in other series, except for cataract which was highly prevalent but mild and did not contribute significantly to loss of vision.
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Affiliation(s)
- M Al-Till
- Ophthalmology Department, Jordan University Hospital, Amman.
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35
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Abstract
There have been major changes over the past 5 to 10 years in our understanding of both the chemical basis for and the surgical treatment of cataract in infants and children. Important questions that remain to be answered include the appropriate power and design selection criteria for intraocular lens implantation, as well as management of the posterior capsule and long-term refractive sequelae. In the past 10 years, there have been radical changes in the management of visually significant cataract in the infant and child. Whereas lens removal, subtotal posterior capsulectomy, vitrectomy, and aphakia were once the standard of care, many physicians now feel that small incisions, phacoemulsification technology, and intraocular lenses (IOLs) are best for these patients. Work is continuing to accumulate a significant body of evidence to evaluate results of these changes in technique and to develop optimal IOL designs and selection criteria for these specialized cataract patients.
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Affiliation(s)
- M B Hamill
- Baylor College of Medicine, Cullen Eye Institute, Department of Ophthalmology, Houston, TX 77030, USA
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