Abstract

Cataract is a very rarely encountered disease during childhood and in children with diabetes it has a prevalence of<1%. Risk factors: adolescence, history of long lasting hyperglycemia, diabetic ketoacidosis at onset, high level of HbA1c at onset and possibly genetic factors.

Authors present the case of a 15 years boy, previously healthy, with history of type 2 diabetes, who presented acquired bilateral cataract immediately after diagnosis of diabetes. The adolescent presented clinical signs of diabetes, polyuria, polydipsia, severe weight loss, 4 weeks before the admission, and at admission he presented a severe form diabetic ketoacidosis. Biological tests at the onset of diabetes revealed: glycemia 900 mg/dl, HbA1c 16,4%, C Peptide 2.23 ng/ml, severe hydroelectrolytic modifications, autoantibodies were in normal range. Haematological, hepatic, renal tests and tyroid function were in normal range. Multiple dose insulin injection therapy with insulin analogues was administered from onset of diabetes. In evolution, the adolescent entered in remission period after 4 weeks from onset; the necessary of insulin in this period was<0,1 UI/kg, for 6 months. Currently, one year after the onset, weight (58 kg ), height (168 cm) and BMI (20) are normal, but the necessary of insulin increased again at 1.2 UI/kg/day. Ophthalmologic examination revealed a slightly positive evolution, posterior subcapsular densifications are delicate, he does not have vision disturbances. Paraclinical examinations reveal: HbA1c 5,9%, C Peptide 2,18 ng/ml, autoantibodies continue to be in normal range. At this adolescent it was difficult to establish the clinical form of diabetes mellitus.

The presence of visual disturbances in children with diabetes mellitus in the first weeks or months after onset should raise suspicion of a possible cataract, so it is necessary to perform a complete ophthalmological examination. Therefore, early diagnosis is essential for sight preservation.