Harold P Koller

Balloon Catheter Dilatation for Treatment of Congenital Nasolacrimal Duct Obstruction

Purpose To determine the efficacy of balloon catheter dilatation to treat congenital nasolacrimal duct obstruction in children over 12 months of age and in children who had failed lacrimal system probing or silicone intubation. Methods We performed a prospective study of balloon catheter dilatation for congenital nasolacrimal duct obstruction in 61 lacrimal systems of 51 patients with an age range of 13 to 73 months (mean, 26 months). Twenty-seven lacrimal systems (44.3%) had no previous procedures, 21 lacrimal systems (34.4%) had one or more failed probings, and 13 lacrimal systems (21.3%) had failed silicone intubation. Infection was eliminated or suppressed preoperatively with a ten-day course of systemic and topical antibiotics. Oral and topical antibiotics were continued for ten days after surgery. Oral prednisone was administered for five days after surgery. One percent prednisolone acetate eyedrops were used for ten days after surgery. Patency was defined as absence of tearing or discharge after the sixth postoperative week, a lack of discharge and a normal tear meniscus on examination, and a normal dye disappearance test. Results Twenty-six (96%) of the 27 lacrimal drainage systems that had balloon catheter dilatation as a primary procedure were patent after surgery. Thirty-two (94%) of the 34 lacrimal drainage systems that had undergone previous probing or silicone intubation were patent after balloon catheter dilatation. Overall, 58 (95%) of 61 lacrimal drainage systems were patent after balloon catheter dilatation. Conclusion Balloon catheter dilatation is generally effective in the treatment of congenital nasolacrimal duct obstruction as a primary procedure in children over 12 months of age, and as a procedure after failure of lacrimal system probing or silicone intubation.

The Surgical and Nonsurgical Management of Persistent Hyperplastic Prima Vitreous

Fifteen patients (16 eyes) with persistent hyperplastic primary vitreous (PHPV) were followed from one to four years. All but one of the nine eyes in the nonsurgical group showed progressive deterioration. A closed intraocular microsurgical (CIOM) approach posterior to the limbus was used in seven eyes. Three intraoperative complications involving the retina occurred because the retina in these cases inserted directly into the pars plicata and due to the presence of a thick, well-formed vitreous gel. Anterior placement of incisions is recommended to avoid intraoperative complications in small eyes. Early CIOM management is suggested in selected cases of PHPV to prevent progressive deterioration leading to phthisis and to afford reasonable cosmetic improvements.

An ophthalmologist's approach to visual processing/learning differences

In the past, most ophthalmologists read or were told that treatment of the disorders affecting children with dyslexia and other learning disabilities fell outside the field of ophthalmology because the brain, and not the eyes, is the main organ active in the process of thinking and learning (Hartstein, 1971; Hartstein & Gable, 1984; Miller, 1988). Because dyslexia, for example, implied an inability to understand the written word, the definitive diagnosis and therapy was in the hands of the educators and clinical psychologists, not the ophthalmologist. The role of an ophthalmologist, thus, was to rule out disease as the first step in determining the reason for a learning difference before referring the child back to the pediatrician or family doctor for further evaluation and referral. This limited role for ophthalmologists in treating children with learning disorders is now being displaced by a move toward an interdisciplinary approach. The ophthalmologist is often the first expert to whom the pediatrician refers a child suspected of having a learning disorder. Educating ophthalmologists in the medical and nonmedical conditions and situations that could affect learning in a child or older individual will help ensure that a patient receives appropriate, effective, and timely remedial treatment. The first step in educating ophthalmologists is to introduce psychiatry, educational and neuropsychology, physical and occupational therapy, and educational science in all its forms relating to learning differences in children and adults to the ophthalmology community (Koller & Goldberg, 1999). (An appendix to this chapter outlines briefly what an ophthalmologist in general practice should know about learning disorders.) The second is to make the diagnosis and treatment of children more efficient by developing a system for classifying disorders that is oriented toward ophthalmologists. This chapter describes such a classification system for learning disorders. It then goes on to describe causes and treatment of medically based ophthalmic problems affecting learning, as well as other conditions affecting learning that are not purely ophthalmic but which ophthalmologists can help diagnose (Koller, 1999a).

Balloon Catheter Dilatation for Treatment of Congenital Nasolacrimal Duct Obstruction: Author Reply

PURPOSE To determine the efficacy of balloon catheter dilatation to treat congenital nasolacrimal duct obstruction in children over 12 months of age and in children who had failed lacrimal system probing or silicone intubation. METHODS We performed a prospective study of balloon catheter dilatation for congenital nasolacrimal duct obstruction in 61 lacrimal systems of 51 patients with an age range of 13 to 73 months (mean, 26 months). Twenty-seven lacrimal systems (44.3%) had no previous procedures, 21 lacrimal system (34.4%) had one or more failed probings, and 13 lacrimal system (21.3%) had failed silicone intubation. Infection was eliminated or suppressed preoperatively with a ten-day course of systemic and topical antibiotics. Oral and topical antibiotics were continued for ten days after surgery. Oral prednisone was administered for five days after surgery. One percent prednisolone acetate eyedrops were for ten days after surgery. Patency was defined as absence of tearing or discharge after the sixth postoperative week, a lack of discharge and a normal tear meniscus on examination, and a normal dye disappearance test. RESULTS Twenty-six (96%) of the 27 lacrimal drainage systems that had balloon catheter dilatation as a primary procedure were patent after surgery. Thirty-two (94%) of the 34 lacrimal drainage systems that had undergone previous probing or silicone intubation were patent after balloon catheter dilatation. Overall, 58 (95%) of 61 lacrimal drainage systems were patent after balloon catheter dilatation. CONCLUSION Balloon catheter dilatation is generally effective in the treatment of congenital nasolacrimal duct obstruction as a primary procedure in children over 12 months of age, and as a procedure after failure of lacrimal system probing or silicone intubation.