Article

Case report

Bilateral cataract in a teenage girl with type 1 diabetes

(T1D): case report
Djibril Boiro, Lamine Thiam, Idrissa Basse, Mar Ndiaye, Aliou Abdoulaye Ndongo, Ndiogou Seck, Amadou Sow,
Babacar Niang, Demba Diedhiou, Modou Gueye, Ousmane Ndiaye

Corresponding author: Djibril Boiro, Abass Ndao Hospital, Cheikh Anta Diop University Dakar, Dakar, Senegal.
djibrilboiro@yahoo.fr

Received: 22 Jun 2021 - Accepted: 25 Jul 2021 - Published: 29 Jul 2021

Keywords: Cataract, type 1 diabetes, adolescent, case report

Copyright: Djibril Boiro et al. PAMJ Clinical Medicine (ISSN: 2707-2797). This is an Open Access article distributed under
the terms of the Creative Commons Attribution International 4.0 License
(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.

Cite this article: Djibril Boiro et al. Bilateral cataract in a teenage girl with type 1 diabetes (T1D): case report. PAMJ
Clinical Medicine. 2021;6(35). 10.11604/pamj-cm.2021.6.35.30477

Available online at: https://www.clinical-medicine.panafrican-med-journal.com//content/article/6/35/full

Bilateral cataract in a teenage girl with type 1
diabetes (T1D): case report
1,& 2 3
Djibril Boiro , Lamine Thiam , Idrissa Basse , Mar
Ndiaye4, Aliou Abdoulaye Ndongo1, Ndiogou Seck 5,
Amadou Sow1, Babacar Niang1, Demba Diedhiou1,
Modou Gueye1, Ousmane Ndiaye1
1
Abass Ndao Hospital, Cheikh Anta Diop University
Dakar, Dakar, Senegal, 2De la Paix Hospital, Assane
Seck University Ziguinchor, Ziguinchor, Senegal,
3
Diamniadio Children Hospital, Iba Der Thiam
University Thies, Thies, Senegal, 4Ophthalmology
Practice Fann Residence Dakar, Dakar, Senegal,
5
Regional Hospital Center, Gaston Berger University
Saint Louis, Saint Louis, Senegal
&
Corresponding author
Djibril Boiro, Abass Ndao Hospital, Cheikh Anta
Diop University Dakar, Dakar, Senegal
Abstract
Cataract is a rare complication in young type 1
diabetics. We describe the case of an 18-year-old
adolescent girl with diabetes since the age of 12
following diabetic ketoacidosis. She was on regular
insulin with a premix and a rapid. She had poorly
balanced diabetes with an annual HbA1c averaging
10.6%. During diagnosis, she complained of ocular
pain and a reduced visual acuity confirmed at 1/10.
Clouding of the lens was identified and she received
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surgical intervention. The postoperative course was
good with a visual acuity recovery of 8/10 and a
normal ocular fundus. Cataracts should be screened
for in young diabetics as well as other complications
related to type 1 diabetes (T1D).
Introduction
A cataract is a rare ocular complication of T1D
among pediatric patients with an estimated
prevalence of 0.7% to 3.4% [1]. It can go up to 16%
in Haitian or African patients [2]. The
pathophysiological mechanisms of cataract
formation at the onset of T1D have not been fully
elucidated. The most widely accepted theory is the
activation of the polyol pathway, osmotic damage,
and oxidative stress due to hyperglycemia leading
to clouding of the lens in diabetic patients [3].
Surgical treatment remains the gold standard [4].
We describe the case of a teenage girl who
suddenly presented a severe decline of the visual
acuity.
Patient and observation
Patient and observation: it was an 18-year-old
teenage girl with type 1 diabetes discovered during
ketoacidosis in 2014 and followed in our
department since 2018. Her mother has type 2
diabetes, there is no parental consanguinity and no
history of familial cataract. She had menstruated at
the age of 13 and is currently in high school. She
was on insulin with three injections per day with a
premixed (Rapid-NPH) 30/70 in the morning and
evening as well as a rapid at noon, for a total
0.7IU/kg day. She ate three meals and snacks often
in between meals. Blood sugar control is rare. She
practices physical activity (gymnastics) for 5 hours
per week. She had several hospitalizations for
ketoacidosis. Her average glycated hemoglobin
over the past year was at 10.6%. She complained of
bilateral eye pain with reduced visual acuity for
several months.
Clinical findings: on examination: weight: 55kg,
height: 177cm, BMI: 17.57kg/m2, PA100/70mmHg.
Djibril Boiro et al. PAMJ-CM - 6(35). 29 Jul 2021. - Page numbers not for citation purposes.
The general condition was maintained, and the rest
of physical examination was within normal limits.
The search for microalbuminuria was negative; an
ophthalmic consultation with fundus examination
was requested.
Diagnosis: at diagnosis, the ophthalmologic
examination (Table 1) found a visual acuity of 1/10
on the right and just a light perception on the left.
Examination of the lens of both eyes revealed
cataracts (Figure 1) and an inaccessible fundus. The
diagnosis of secondary bilateral cataract to poorly
balanced diabetes was made.
Therapeutic interventions: two cataract surgeries
15 days apart were performed after strict glycemic
control and ocular echobiometry. We performed an
extra capsular extraction (Figure 2) with the
placement of a posterior chamber implant under
sub-tenonian anesthesia.
Follow-up and outcome of interventions: the
postoperative course was normal for both eyes.
The stitches were removed 60 days after surgery
for each eye. We noted secondary capsulosis in the
right eye which prompted a needle capsulotomy
under local anesthesia. At the control examination
(Table 2), visual acuity was normalized to 8/10 for
both eyes. Bilateral pseudophakia was noted
(Figure 3) and the retinograph (Figure 4) was
normal on both sides.
Discussion
A cataract may be the first sign of T1D or it occurs
within 6 months of a diagnosis of T1D in most
pediatric patients [5]. For our patient, the diagnosis
was made 6 years after the diagnosis of diabetes. It
appears to be a late onset or delayed diagnosis in
the absence of an ophthalmologic consultation.
Authors have diagnosed cases of cataracts one
month before the diagnosis of diabetes. Some
cases was diagnosed one month before the
diagnosis of diabetes [5]. The diagnosis age varies.
Wilson et al. reported the average age of diagnosis
at 11.7 years. The youngest patients described in
the literature with early diabetic cataracts were 5
2
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years old, but many patients were adolescents as in
our case [6,7]. Most authors have reported that
cataracts were significantly associated with female
patients [8,9]. However, Lafusco et al. reported an
equal gender distribution in the pediatric
population with T1D [7]. Our patient had several
hospitalizations for ketoacidosis. Her average
glycated hemoglobin over the past year was 10.6%.
High blood sugar and hemoglobin A1c levels at the
time of diagnosis are associated with an increased
risk of developing cataracts [7,10]. Lafisco et al.
showed in their study that for each percentage
point of 12.8 to 14.1% of the level of HbA1c, the
appearance of early diabetic cataract increased by
3.6 times [7]. Currently, there are many
experimental therapies for the treatment of
diabetic cataracts, but cataract surgery remains the
gold standard in the treatment of diabetic
cataracts [11]. The postoperative course is
generally favorable with good recovery of the visual
acuity. According to Wilson et al. nineteen out of
twenty-three operated eyes had better
postoperative visual acuity corrected at 20/40 or
better [5].
Conclusion
Although rare, cataracts in young diabetics must be
screened as well as other complications of type 1
diabetes. Surgery is essential but is not without risk,
hence the importance of emphasizing prevention
by improving the patients' glycemic control.
Competing interests
The authors declare no competing interests.
Authors' contributions
Djibril Boiro; final draft. Lamine Thiam;
bibliographic search. Idrissa Basse; formatting first
draft. Mar Ndiaye; drafting of the ophthalmology
section. Aliou Abdoulaye Ndongo Aliou A. Ndongo,
Ndiogou Seck, Amadou Sow, Babacar Niang,
Demba Diedhiou, Modou Gueye, Ousmane Ndiaye;
Djibril Boiro et al. PAMJ-CM - 6(35). 29 Jul 2021. - Page numbers not for citation purposes.
corrections and contributions. All the authors have
read and agreed to the final manuscript.
Tables and figures
Table 1: results of the ophthalmological
examination
Table 2: results of the ophthalmologic examination
after surgery
Figure 1: examination of the lens of both eyes
revealed cataracts and an inaccessible fundus (A:
right eye, B: left eye)
Figure 2: lens after extra capsular extraction
Figure 3: eyes after cataract extraction (A: right eye,
B: left eye)
Figure 4: normal retinography on both sides (A:
right eye, B: left eye)
References
1. Šimunović M, Paradžik M, Škrabić R, Unić I,
Bućan K, Škrabić V. Cataract as early ocular
complication in children and adolescents
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diabetes. Pediatr Diabetes. 2018 Apr 26.
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Scholar
Table 1: results of the ophthalmological examination
Right eye
visual acuity without
1/10
correction
Appendices healthy
previous segment Clear cornea Quiet anterior chamber Clear cornea Quiet anterior
of normal depth Positive photomotor chamber of normal depth Positive
reflex
Lens Cataract C3N2P3 (LOCS III)
Ocular tension 16mmHg
Retinography inaccessible
Djibril Boiro et al. PAMJ-CM - 6(35). 29 Jul 2021. - Page numbers not for citation purposes.
9. Wen-Li L, Po-Chih S, Chen-Hao L, Yu-Tsun S,
Li-Min C. High risk of arly cataracts in young
type 1 diabetes group: a nationwide cohort
study. International Journal of
Endocrinology. 2020;8160256. Google
Scholar
10. Datta V, Swift PG, Woodruff GH, Harris RF.
Metabolic cataracts in newly diagnosed
diabetes. Arch Dis Child. 1997 Feb;76(2):
118-20. PubMed| Google Scholar
11. Marko Šimunović, Martina Paradžik, Roko
Škrabić, Ivana Unić, Kajo Bućan, Veselin
Škrabić. Cataract as early ocular
complication in children and adolescents
with type 1 diabetes mellitus. Int J
Endocrinol. 2018 Mar 20;2018: 6763586.
PubMed| Google Scholar
Left eye
Positive light perception
healthy
photomotor reflex
Cataract C4N2P3 (LOCS III) Closure
16mmHg
inaccesible
4
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Table 2: results of the ophthalmologic examination after surgery
Right eye Left eye
Visual acuity with +2.25 (-1.50 à 30) add +3.00 +2.00 (-1.00 à 175) add +3.00
correction
Far 8/10 8/10
Close P2 P2
Appendices healthy healthy
Previous segment Clear cornea Clear cornea
Quiet anterior chamber of Quiet anterior chamber of
normal depth normal depth
Positive photomotor reflex Positive photomotor reflex
Lens Pseudophakia Pseudophakia
Qcular tension 16mmHg 16mmHg
Retinographiy Healthy optic disc and macula Healthy optic disc and macula
Normal retinal vessels and Normal retinal vessels and
fields fields
Absence of diabetic Absence of diabetic
retinopathy retinopathy

Figure 1: examination of the lens of both eyes revealed cataracts and an inaccessible fundus (A: right
eye, B: left eye)

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Figure 2: lens after extra capsular extraction

Figure 3: eyes after cataract extraction (A: right eye, B: left eye)

Djibril Boiro et al. PAMJ-CM - 6(35). 29 Jul 2021. - Page numbers not for citation purposes. 6
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Figure 4: normal retinography on both sides (A: right eye,

B: left eye)

Djibril Boiro et al. PAMJ-CM - 6(35). 29 Jul 2021. - Page numbers not for citation purposes. 7