Early Cataract and Surgical Recovery in Young Type 1 Diabetics: Experiences from a Single Centre in Northern India

Abstract

Introduction: Cataract, a non-retinal ophthalmic complication, is the leading cause of visual impairment in adults living with Type 1 Diabetes (T1D). Unfortunately, there is a dearth of data on diabetic cataract in the paediatric population, particularly from developing countries. To the best of our knowledge, the current study is the first and the largest observational study reporting the characteristics, and surgical recovery of early cataract among Indian children and adolescents living with T1D. Aim: To report the patient characteristics and surgical outcome of early cataract in young type 1 diabetics. Materials and Methods: The present study was a retrospective observational study (January 2005-December 2020), conducted at Regency Hospital Pvt. Ltd., Kanpur, Uttar Pradesh, India. Medical records of Children and adolescents (n=150) aged 1-18 years with T1D in the last 15 years, and who developed cataract during follow-up were included in the study and reviewed from January 2021 to March 2021 , for the socio-demographic details, age at which diabetes was diagnosed, presence or absence of ketoacidosis at the time of diagnosis of diabetes, age at which cataract was diagnosed, glycaemic control, morphology and laterality of cataract, history of retinopathy before cataract surgery, presence or absence of concomitant nephropathy, visual acuity at the time of cataract diagnosis, type of surgical intervention done and visual acuity following surgery. Results: Out of 150 T1D patients, a total of ten patients (five boys; 19 eyes) were diagnosed with cataract, before the age of 18 years. The mean age at diagnosis of T1D was 8.6±3.2 years (range, 3-12 years) and cataract was 13.2±4.1 years (range, 6-18 years). Mean HbA1c at the time of cataract diagnosis was 7.99±0.98%. The past history of diabetic ketoacidosis was documented in six patients (60%). Nearly 70% (n=7) patients belonged to the lower socio-economic strata. Cortical cataract (12/19 eyes; 63%) was the most common morphology identified. These patients were operated after a mean duration of 0.5±0.7 years of cataract diagnosis. The corrected visual acuity remained good after a mean follow-up duration of 3.2±2.7 years (range 0-8 years), post cataract extraction. Conclusion: The experiences gained from this study reinforce the need for early cataract screening in the paediatric diabetic population, especially in those, belonging to lower socioeconomic strata, and/or with history of diabetic ketoacidosis. Cortical cataract was the most common form identified. Vision can be preserved with timely surgical intervention.