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| PHOTO ESSAY |
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| Year : 2021 | Volume
: 1
| Issue : 4 | Page : 808-809 |
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Snowflake cataract: Diabetic cataract
D Bala Saraswathy, Kalpana Narendran
Department of Cataract Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| Date of Submission | 17-Feb-2021 |
| Date of Acceptance | 24-Mar-2021 |
| Date of Web Publication | 09-Oct-2021 |
Correspondence Address:
Dr. D Bala Saraswathy
Aravind Eye Hospital, Civil Aerodrome Post, Sitra, Coimbatore, Tamil Nadu - 641 014
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_397_21
Keywords: Cataract, diabetes, snowflake
How to cite this article:
Saraswathy D B, Narendran K. Snowflake cataract: Diabetic cataract. Indian J Ophthalmol Case Rep 2021;1:808-9 |
A 21-year-old boy came with complaints of defective vision in both eyes for 1 year. He is a known case of type 1 diabetes mellitus on insulin treatment since childhood. His best corrected visual acuity (BCVA) in right eye is 3/60 and left eye 6/18. On anterior segment examination, he was found to have grayish-white sheet-like opacities in cortical area [Figure 1] with anterior subcapsular cataract [Figure 2] and [Figure 3] consistent with snowflake cataract in both eyes. His IOP and all other investigations were normal. Posterior segment was hazy and B SCAN was normal in both eyes. He had history of uncontrolled sugar 4 to 5 years back after which there was a gradual diminution of vision. His blood sugars are controlled now for the past 1 year. He was advised right eye phacoemulsification with intraocular lens implantation surgery since snowflake cataract was associated with anterior subcapsular cataract. | Figure 1: Snowflake cataract, arrow mark showing white flaky cortical fibers resembling snowflake
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 | Figure 2: Snowflake cataract with anterior subcapsular cataract indicated by arrow mark
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 | Figure 3: Snowflake cataract in left eye with less involvement than right eye
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| Discussion | |  |
Cataract are common in diabetes patients especially with uncontrolled blood sugar and longer duration.[1],[2] Because of osmotic swelling of lens fiber due to metabolic changes in type 1 diabetes mellitus, opacification of cortical lens fibers occurs.[3] Special type of diabetic cataract—snowflake cataract—are very uncommon and are seen in type 1 diabetes patients with uncontrolled blood sugar. Cataracts may be reversible in young patients when the blood sugars are controlled.[4] Cataract surgery is preferred for such patients since fundus examination is difficult with lens opacities and may lead to potential retinopathy complications later if left untreated. After cataract surgery, NSAIDs are being used to reduce postoperative inflammation and cystoid macula edema.[5]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Kahn HA, Leibowitz HM, Ganley JP, Kini MM, Colton T, Nickerson RS, et al. The Framingham eye study. II. Association of ophthalmic pathology with single variables previously measured in the Framingham heart study. Am J Epidemiol 1977;106:33-41.  |
| 2. | Harding JJ, Egerton M, van Heyningen R, Harding RS. Diabetes, glaucoma, sex, and cataract: Analysis of combined data from two case controlled studies. Br J Ophthalmol 1993;77:2-6. |
| 3. | Srivastava SK, Ramana KV, Bhatnagar A. Role of aldose reductase and oxidative damage in diabetes and the consequent potential for therapeutic options. Endocr Rev 2005;26:380-92. |
| 4. | Pollreisz A, Schmidt-Erfurth U. Diabetic cataract-pathogenesis, epidemiology and treatment. J Ophthalmol 2010;2010:608751. |
| 5. | Wolf EJ, Braunstein A, Shih C, Braunstein RE. Incidence of visually significant pseudophakic macular edema after uneventful phacoemulsification in patients treated with nepafenac. J Cataract Refract Surg 2007;33:1546-9. |
[Figure 1], [Figure 2], [Figure 3]
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