Emerging challenges of acute bilateral diabetic cataract in pediatric: insight to early detection and management–a case report

Background: Type I diabetes mellitus (DM) is a chronic metabolic systemic disease that continues to increase in prevalence in children. This prolonged condition of hyperglycemia affects the integrity of ocular microvascular structures including cataract formation as the most common complication and leading cause of global blindness. Case Report: A 17-year-old male patient complained of blurry vision and glare in both eyes (BE) for 3 months in newly diagnosed T1DM. Visual Acuity (VA) was 6/45PH6/21f2, with correction S-1.50 advancing to 6/18 in BE. Slit lamp examination revealed lens opacity (P3), central, 3mm, retinometry 0.32. Posterior segment evaluation and intraocular pressure (IOP) were within normal limits. Right eye(RE) underwent lensectomy with IOL under general anesthesia. Discussion: Post-operative RE with final VA of 6/18 PHNI and IOP of 43 mmHg. The patient was given antiinflammation eyedrops oral and topical antiglaucoma, and achieved final IOP of 8mmHg within 3 days and remains stable without antiglaucoma. The result was satisfying despite uncomplicated secondary glaucoma as a short-term complication that resolved with therapy. Conclusion: Early detection for ocular complications in DM is needed as the cataract genesis process is still progressing despite good glycemic control. Ocular manifestation may present as an early sign of undiagnosed T1DM or as its complications. Comprehensive multidiscipline treatment, glycemic control, and routine evaluation are essential for the success of metabolic cataract therapy and the progression of microvascular complications due to DM. Lensectomy with IOL implantation is still the mainstay therapy in pediatric cataracts. Awareness plays a vital role as it possibly causes decreased vision and or amblyopia, leading to blindness.