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Cataract

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Dear Group,

I have got a 43 year old male patient, who has developed extensive cataract in the posterior chamber of the right eye. The onset has been quite drastic developing over only 6-8 weeks. Over about 5 months his cholesterol has shut up to 6.8, his LDL has gone to 3.9, his HDL to 1.0, and his triglycerides to 4.08. His anion gap and creatinine is slightly low, and his chloride and magnesium slightly elevated. He has superfit all his life with a blood pressure around 95/55 and a resting pulse around 50. The last 3 years he has done no exercise at all, been drinking more alcohol than previously (2-3 glasses of redwine per day), and he has been going through EXTREME stress, and his blood pressure is now 125/70, and his pulse 80. He has complained about episodes of aches/stabs/tightness in the heart-region, but not always in the same area. He has developed a chronic low-grade inflamatory ache in the right acromio-clavicular joint, and over the last few weeks he has also had extensive numbness/pins and needles in both hands, and very slight in both feets - mainly at night. He was on intravenous antibiotic drip for a peritonsilar abscess 5 months ago - which eventually ruptured externally. At that time he also complained about the heart region symptoms, but sonar, ECG and stress-ECG were all negative, as was the blood-picture, except cholesterol being 5.3.

There is no personal or familie historie of diabetes, heart-problems or thyroid-problems. The patient is 5 kg over his ideal weight, originates from Northeren Europe, but has been living in Africa for the last 13 years in strong sunlight. He had the Lasek-laser operation for short-sightedeness 11 years ago, and his vision has been perfect untill 1 year ago and is now -0.50 on the left and

+0.75 0n the right.

Ophthalmic examination with pupil dilation reveals no traces of cataract in the left eye and the blood vessels appear normal.

What causes cataract to develop so rapidly in such a relative young individual, and is there an alternative to an operation? Can this type of cataract be reversed? Has anybody got any experience with such early onset?

What is the risk of recurrence after an op?

Any input will be highly appreciated - the patient is scheduled for surgery on 18th of January.

Thank you for being there,

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