Eye M.D.’s stunned to consider that …
Can Reverse Cataracts
Rapid development and nonsurgical resolution of
significant cataracts is extremely rare
By Will Block
n a recent letter to the Archives of Ophthalmology, a peer-reviewed journal, researchers at the Havener Eye Institute at Ohio State University report an unusual regression of cataracts. Their observations followed orthopedic surgery for a 45-year-old man with Charcot-Marie-Tooth disease (CMTD). This disease is a group of disorders that affect peripheral nerves outside the brain and spine. One of the most common nerve-related disorders, CMTD is passed down through families, and varies dependent on which of at least 40 genes are affected. The disease leads to damage or destruction to the myelin insulation sheath covering around nerve fibers.
Figure 1. External photographs of the right (A) and left (B) eyes showing cataracts at the initial visit, and photographs of the right (C) and left (D) eyes showing complete resolution of cataracts at follow-up.
Rapid Formation of Cataracts, then Complete Regression
After surgery and the rapid development of bilateral cataracts, the patient’s cataracts then resolved, regressing completely within 45 days of surgery (see Figure 1). When the cataracts first formed, the patient was referred for what constituted a third opinion regarding his vision loss. This loss began 2 days after the surgery—a 4-hour, unremarkable procedure for a foot deformity due to type 2 CMTD, resulting from an axonal neuropathy, a nerve fiber disorder.
Researchers at the Havener Eye
Institute at Ohio State University
report an unusual
regression of cataracts.
The patient’s medical history was otherwise unexceptional, based on basic metabolic panel and complete blood cell count findings. After surgery, his blood chemistry was unremarkable, except for hypokalemia (low potassium levels in the blood).
Standard operative medications were delivered, including the following: cefazolin (an antibiotic used mainly used to treat bacterial infections of the skin), ropivacaine hydrochloride (a local anesthetic used to produce peripheral nerve block), midazolam (a benzodiazepine sedative, used as a skeletal muscle relaxant), fentanyl citrate (a synthetic narcotic analgesic with a rapid onset and short duration of action, used before induction), lidocaine (a common local anesthetic and antiarrhythmic drug), propofol (a short-acting, intravenously administered hypnotic agent), rocuronium bromide (a muscle relaxant used in modern anaesthesia), and ondansetron hydrochloride (an antiemetic used to treat possible nausea and vomiting). That’s a lot of drugs. Nevertheless, the case was without complications of any sort.
More drugs! Postoperatively, the patient’s pain was controlled with hydromorphone hydrochloride (a very potent centrally-acting analgesic drug of the opioid class). During his hospital stay, he received nasal mupirocin (an antibiotic used to treat skin infections caused by bacteria), docusate sodium (a laxative for stool softening), and potassium chloride (to replenish low potassium levels). The patient was discharged on postoperative day 1 with oxycodone hydrochloride (an opiate analgesic used to relieve pain), along with his usual home “medications:” the nutritional supplements α-lipoic acid (400 mg/d); ascorbic acid (500 mg/d); coenzyme Q10 (600 mg/d); a daily vitamin B complex; and a daily multivitamin.
Vision Also Improved
On medical examination, 29 days after surgery, the patient’s best-corrected visual acuity was 20/40 for both eyes (while wearing contact lenses). Intraocular pressure measured 15 mm Hg in both eyes. Slitlamp examination—a slitlamp is an instrument consisting of a high-intensity light source that can be focused to shine a thin sheet of light into the eye)—results were unremarkable except for significant bilateral posterior cortical cataracts and a Mittendorf dot in the left eye. This eye anomaly, characterized by the presence of a small dense floating opacity behind the posterior lens capsule, is a remnant of the hyaloid artery that was present in the eye during embryonic development, when it was used to supply nutrients to the developing lens in the growing fetus. A Mittendorf dot usually does not affect vision.
Other tests given—including a fundus examination (dilation of the eyes to create a better view), optical coherence tomography (an optical signal acquisition and processing method), and fluorescein angiography (a technique for examining the circulation of the retina using the dye tracing method) findings—were normal. Thereafter, the patient was scheduled for a cataract extraction evaluation. However, when seen 16 days later in follow-up, the patient described resolution of his vision loss after 1 week of self-initiating the use of an eyedrop containing N-acetylcarnosine, 1%, dosed at 2 drops 4 times daily in each eye.
The patient described resolution of
his vision loss after 1 week of
self-initiating the use of an eyedrop
containing N-Acetylcarnosine, 1%,
dosed at 2 drops 4 times
daily in each eye.
In addition, the best-corrected visual acuity improved to 20/30 (right eye) and 20/25 (left eye). An examination revealed complete resolution of the cataracts (see Figure 1). The authors of this case study commented that the mechanism of such a rapid formation of posterior cortical cataracts following orthopedic surgery for CMTD is unknown. Yet, the eye examination just prior to the foot surgery showed no cataracts. A PubMed (National Academy of Medicine) search found no association of any of the medications used associated to cataract. However, the researchers did not appear to look at anything that could have dissipated the cataracts, such as N-acetylcarnosine.
Type 2 CMTD is frequently associated with a connexin gap junction mutation (among several other mutations). In fact, connexins have long been studied in cataractogenesis and are known to be involved in metabolite, ion, and water transport between lens fibers. There are also reports of cataract formation in dynamin-mutated type 2 CMTD, but there are no reports to the researcher’s knowledge of a spontaneously regressing cataract as seen in the case. Dynamins are hydrolase enzymes that cause cells to absorb molecules.
Nor did the scientists who searched the literature for the other known genes for type 2 CMTD discover any association with cataracts. However, reports of spontaneously resolving cataracts have been noted following intraocular surgery. These were thought to arise from several potential mechanisms, one being impaired sodium potassium adenosine triphosphatase channels with electrolyte imbalance. The feathering sutural cataracts noted in these studies were similar to those found in the patient (see Figure 1). This finding, along with gap junction and dynamin studies, suggests a brief osmotic imbalance as a potential cause.
Other spontaneously resolving cataracts have been previously reported, usually associated with significant metabolic disease or intralenticular trauma. These reports offer suggestions of potential resolving mechanisms involving lens epithelial growth and reestablishment of ionic balance.
The importance of the patient’s nutritional supplements and N-acetylcarnosine eyedrops in his cataract resolution is unknown. However, they seem far more likely to offer an explanation of the cataract regression, especially if one searches PubMed with the relevant terms. Wouldn’t you know, the researchers thought that further independent research of clinical effectiveness is still needed to validate research claims of N-acetylcarnosine. As Toh et al. indicate, there have been significant conflicts of interests in humans. How predictable is that? There are 34 articles on N-acetylcarnosine and cataracts in PubMed.
- Cloud A, Tandon A, Calhoun J, Cebulla CM. Rapid formation and resolution of cataracts following orthopedic surgery for a patient with Charcot-Marie-Tooth disease. Arch Ophthalmol 2012 Feb;130(2):260-2.
- Krutovskikh V, Yamasaki H. Connexin gene mutations in human genetic diseases. Mutat Res 2000;462(2-3):197-207.
- Claeys KG, Züchner S, Kennerson M, et al. Phenotypic spectrum of dynamin 2 mutations in Charcot-Marie-Tooth neuropathy. Brain 2009;132(pt 7):1741-52.
- Petermeier K, Szurman P, Bartz-Schmidt UK, Gekeler F. Pathophysiology ofcataract formation after vitrectomy [in German]. Klin Monbl Augenheilkd 2010;227(3):175-180.
- Rofagha S, Day S, Winn BJ, Ou JI, Bhisitkul RB, Chiu CS. Spontaneous resolution of a traumatic cataract caused by an intralenticular foreign body. J Cataract Refract Surg 2008;34(6):1033-5.
- Toh T, Morton J, Coxon J, Elder MJ. Medical treatment of cataract. Clin Experiment Ophthalmol 2007;35(7):664-71.
Will Block is the publisher and editorial director of Life Enhancement magazine.