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Biomedical subjects

P Fells

Publications and source records attributed to P Fells.

13 recordsLinked to original sources
PubMed1992

A scoring method for Hess charts.

A new scoring system for Hess charts is described. Scores for both horizontal and vertical deviations are calculated from the displacement of individual points on the Hess chart, using weighting factors for the centre, inner and outer zones. The scoring system was validated in a group of 24 patients undergoing surgery for paralytic or restrictive strabismus. Subjective scores were obtained from patients both before and after corrective surgery, and corresponding Hess charts were scored using the new system. There was a good correlation between the changes in subjective and objective score. Our scoring system has applications in both research and clinical practice, allowing objective analysis of changes in muscle balance in a variety of motility disorders.

Diplopia↗
PubMed1992

Aetiology and management of the 'detached' rectus muscle.

The clinical features and management of 17 cases of detached extraocular muscles are described. They are classified into four groups: (1) the muscle which is cut and lost during squint surgery, (2) the muscle which breaks during squint surgery, (3) the muscle which slips following squint surgery, and (4) the muscle which is damaged during facial or orbital trauma. The prognosis for group 1 is poor whereas groups 2-4 have a good chance of successful muscle relocation.

Humans↗
PubMed1979

Cyclic oculomotor palsy.

This rare condition, an oculomotor palsy which is interrupted by spastic contractions of the levator muscle and the pupillary sphincter at fairly regular intervals, had been reported in 54 patients up to 1975. Two patients presented to the authors with apparently complete unilateral ptosis but abnormal pupillary reactions prompted closer examination. Once the diagnosis has been considered only 5 minutes of careful clinical examination are necessary to confirm or reject it. During the past 4 years the authors have found nine new cases of the condition and it is clear that the diagnosis must often be missed. Details of the patients are shown and discussed in the light of Loewenfeld and Thompson's theory of the pathology. The place of surgical treatment is considered.

Adult↗
PubMed1979

Confusion, diplopia, and suppression.

Consideration of the clinical features and animal experimental models suggests that inhibition/suppression is not involved in anisometropic amblyopia. The role of suppression in anomalous correspondence needs further elucidation. Sensory testing in Duane's syndrome, where both BSV and suppression can be highly developed, confirms that diplopia may arise spontaneously at greater ages than previously suspected. The clinical time course of development of strabismic suppression is similar to that of the sensitive period during which binocularity can be established. Blakemore (1978) suggests that it may be more useful to think of a period of heightened sensitivity which tails off gradually. This concept would similarly apply to the time during which suppression may be established which does not have a sharp cut-off at 7 years of age.

Adolescent↗
PubMed1975

Long-term follow-up of orbital blow-out fractures with and without surgery.

The patients having orbital repair for a blow-out fracture, 6 months or longer after injury, had a high incidence of enophthalmos (72%). This compares badly with 17% in the non-surgical group and 20% of those who had surgery within 14 days of trauma. The residual enophthalmos was minimal in the latter two groups, but could measure 2 or 3 mm in the late surgery group. 40% of the late surgery group also needed additional orbital or muscle surgery and the fields of binocular single vision achieved were only moderately good. The good results achieved without surgery do not, of course, mean that patients with blow-out fractures do equally well regardless of surgical treatment. This study has shown that careful clinical and radiological assessment in the first 10 days permits a reasoned decision to be made whether to operate or not on any particular patient.

Diplopia↗
PubMedDate not supplied

The surgical treatment of traumatic Brown syndrome.

We present the results of surgical treatment in 13 patients who attended Moorfields Eye Hospital with traumatic Brown syndrome between 1975 and 1990. The average age was 34 years (range, 18 to 46 years), and in 12 cases the cause was a road traffic accident. Diplopia was the indication for surgery in all cases. Most patients had two surgical procedures; but in two patients, three were required. The outcome was assessed both subjectively and objectively. Objective assessment was by analysis of the preoperative and postoperative fields of binocular single vision and Hess charts which were available for 11 patients. The Hess charts were analyzed using a new scoring system. At final follow up, subjective improvement had occurred in 7 patients, 3 patients reported no improvement, and 3 patients thought their symptoms were worse. The field of binocular single vision improved in 8 patients and was worse in 3 patients. The Hess chart improved in 8 patients and was worse in 3 patients. The management of this difficult condition is discussed.

Adolescent↗