Acute Onset Vision Loss: A Rare Initial Presentation of Diabetes

Presentation Number: SAT 620
Date of Presentation: April 1st, 2017

Jose T Kuzhively*1 and Jessica L Hwang2
1Rush University Medical Center, Berwyn, IL, 2John H Stroger Hospital, Chicago, IL

Abstract

Introduction. Cataract is a common complication in long-standing type 1 or type 2 diabetes. However, acute vision loss from accelerated cataract diagnosed at the onset of type 1 diabetes has very rarely been described, only in pediatric case series. We are reporting a case of acute bilateral cataract as an initial presentation of type I diabetes in an adult.

Case Description. A previously healthy 35-year-old Hispanic male presented with a 2-3 week history of fatigue, polydipsia, polyuria and weight loss, accompanied by rapid deterioration in visual acuity over 2 weeks. Prior to 2 weeks ago, he was working full-time cleaning and reports no prior complaints with vision. He denied eye trauma, exposure to chemicals or family or personal history of eye issues. Physical examination was significant for dehydration, tachycardia and complete lens opacities in both eyes, visual exam notable only for light perception. Laboratory studies (pH of 7.28, anion gap of 23, bicarbonate of 15 mmol/L, urinary ketones 80 mg/dL, blood glucose of 417) were consistent with the diagnosis of diabetic ketoacidosis. The patient was started on intravenous fluids and insulin, and DKA rapidly subsided. Further tests showed HbA1c of 11.6%, positive immunological markers for all antipancreatic islet antibodies (insulin auto antibody, islet cell antibody, IA2 antibody and GAD antibody) along with low serum C-peptide levels (0.11 ng/mL) which confirmed diagnosis of type 1 DM. Ophthalmology evaluation revealed bilateral mature cataracts and patient underwent cataract surgery on his left side after optimizing blood glucose with improvement of vision. On further workup- he had no evidence of retinopathy, neuropathy or nephropathy.

Discussion. Cataracts in diabetic patients are considered among the major causes of visual impairment in developed and developing countries. The mechanisms attributed to cataract formation in these cases of long-standing diabetes include oxidative stress, or accumulation of sorbitol leading to osmotic stress. The only reported cases are in small pediatric case series. The onset of cataracts is usually related to the duration of the condition and acute cases are rare (less than 1%). Whether the mechanism of cataract formation in longstanding versus new onset diabetes is precisely the same or whether there might be other potential etiologies has not been explored. Acute onset of cataract formation has rarely (if ever) been described as initial presentation of Type I DM in adults.

 

Nothing to Disclose: JTK, JLH