Lens

Question 1

What’s the mechanism of unstable refraction in diabetes mellitus?

Answer 1

Hyperglycaemia is reflected as high glucose level of aqueous humour, which diffuses into the lens. Glucose metabolises into sorbitol which accumulate within the lens resulting in secondary osmotic over hydration. Refractory power therefore fluctuates with BSL level, hyperglycaemia associated with myopia and vice versa.

Question 2

Which type of cataract does patients with diabetes get?

Answer 2

Acceleration of nuclear sclerotic cataract. But rarely, you get snowflake cortisol opacities which is classic for diabetic cataract

Question 3

Indication for cataract surgery

Answer 3

Cataract causing difficulty in ADLs
Cataract affecting health of eye e.g. phacolytic or phacomorphic glaucoma
Cataract affecting clarify of ocular media and affecting monitoring or treatment of fundus pathology

Question 4

Risk of cataract surgery

Answer 4

Most cataract surgery straightforward but there is a long list of complications. Most complications can be dealt with easily with no long term damage but I’ll need to mention the rare and serious problems:
1. 1 in 1000 chance you can be left with little to no vision in that eye and 1 in 10000 chance you’ll lose the eye altogether
2. The most devastating complications are a serious infection of the eye (endophthalmitis) and a serious bleeding into the eye (suprachoroidal haemorrhage)
3. Some complications mean you’ll need a second operation of the eye
Anaesthetics risk also buy will be covered by anaesthetist.