Cataract (Congenital/Childhood Cataract)
1. Definition
- Lens
opacity ในเด็ก → ทำให้เกิด visual
impairment
- เป็น cause สำคัญของ childhood
blindness (รักษาได้ถ้าเร็ว)
2. Epidemiology
- congenital
cataract ~1–3/10,000
- รวมทั้งหมด ~1–15/10,000
3. Etiology (high-yield)
3 กลุ่มหลัก
1.
Genetic (~1/3)
o AD
> AR / X-linked
2.
Systemic disease (~1/3)
o TORCH
infection
o metabolic
(eg. galactosemia)
o Down
syndrome
3.
Idiopathic (~1/3)
Other causes
- trauma
- steroid
- radiation
4. Clinical Presentation
4.1 Key presentations
- leukocoria
(white pupil)
- abnormal
red reflex
- poor
visual behavior
4.2 Associated signs
- nystagmus
(late sign → poor
prognosis)
- strabismus
- photophobia
4.3 Important clue
- asymmetry
→ suspect unilateral
cataract
5. Complication (สำคัญมาก 🚨)
👉 Amblyopia
(deprivation amblyopia)
- critical
period: birth–5 ปี
- severe
ถ้าเกิด early + dense
👉 cataract ใน
infancy = ophthalmic emergency
6. Diagnosis
6.1 Screening (สำคัญที่สุด)
- red
reflex test (Bruckner test)
6.2 Ophthalmology
- slit
lamp
- dilated
exam
6.3 Workup (case selected)
- TORCH
- metabolic
(galactosemia)
- genetic
testing
7. Differential Diagnosis (leukocoria) 🚨
- retinoblastoma
(must exclude)
- Coats
disease
- PFV
- retinal
coloboma
8. Management
8.1 Indication for surgery
Absolute
- bilateral
dense cataract
Relative
- VA ≤20/50
- size
>3 mm
- strabismus
/ nystagmus
8.2 Timing (critical point)
👉 surgery ASAP
- optimal:
5–6 weeks of age
- ต้อง clear visual axis ≤16 weeks
👉 delay → irreversible amblyopia
8.3 Surgical approach
- lens
extraction ± IOL
8.4 Optical rehabilitation
<6 เดือน
- aphakic
contact lens (preferred)
>6 เดือน
- IOL
implantation
Adjunct
- glasses
- occlusion
therapy (patching)
9. Postoperative Complications
- secondary
cataract (almost universal in young children)
- glaucoma
(10–20%)
- strabismus
- retinal
detachment
- endophthalmitis
10. Prognosis
ขึ้นกับ
- age
at onset
- timing
of surgery
- unilateral
vs bilateral
- compliance
amblyopia therapy
👉 early treatment → VA 20/20–20/40 possible
11. Clinical Pearls
- leukocoria
= retinoblastoma until proven otherwise
- red
reflex screening สำคัญที่สุด
- cataract
ใน infancy = emergency
- surgery
delay → amblyopia ถาวร
- postoperative
care สำคัญพอๆ กับ surgery
12. Practical Approach (ใช้ในคลินิกทันที)
Infant / child with abnormal red reflex
👉 Step 1: suspect
- leukocoria
/ asymmetry
👉 Step 2: urgent referral
- ophthalmology
(same day–within days)
👉 Step 3: evaluate cause
- history
+ systemic exam
👉 Step 4: treat
- surgery
+ visual rehab
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