Biomedical subjects
Publications and source records attributed to P Fells.
The indications for and details of the technique of adjustable sutures are fully described. Patients with vertical strabismus and fusion give significantly better results with this method. Illustrative cases of dysthyroid ophthalmopathy and superior oblique palsies are described.
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31 patients with bilateral fourth nerve palsies are considered in this paper, 25 of the cases being traumatic in origin. Quantitative estimation of the torsional defect is carried out, using special synoptophore slides and a modification of the Lees' screen technique. Inability to prove the patient's retention of fusion in the presence of torsion is discussed. Although many of the traumatic cases had been rendered unconscious for varying periods of time up to several weeks by the initial injury with the known risk of losing fusion, sixteen out of seventeen patients undergoing surgery for their diplopia had postoperative evidence of binocular single vision.
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.
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.
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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.
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