Biomechanical Analysis in Strabismus Surgery

我们提出了3个相互关联的目标来定义眼旋转（眼外）肌（EOM）的生物力学， 健康和视觉疾病中的视神经（ON），了解新的EOM动作，并表征机械效应 这可能会导致严重近视。我们的目标是改善斜视的治疗， 眼睛的方向;青光眼和非动脉炎性前部缺血性视神经病变（NA-AION），两种常见 致盲性疾病;高度轴性近视，一种眼睛伸长和变形，已成为世界范围内的 流行病和失明的主要原因。我们提出了一个新的和关键的联系连接EOMs，ON和结构， 我们将使用现代成像和人工智能技术探索眼睛的巩膜壁。我会瞄准的 阐明人眼的运动学（运动）特性，通过多位置磁共振进行测试 眼球成像（MRI）和眼外膜（EOM）的假设，平移（线性）运动的重要贡献 到眼睛对齐。MRI将在正常水平会聚和垂直眼球旋转期间进行 人，以及患有常见斜视的患者，包括会聚不足，眼睛交叉 （内斜视）和向外眼偏斜（外斜视），在矫正EOM手术之前和之后。澄清 眼平移是理解正常眼运动和治疗其疾病所必需的。Aim II将 表征由眼球运动引起的ON上的机械负载。我们将描述 在水平和垂直两种尺度下眼球旋转过程中ON牵引负荷对眼球的力学影响 在活人中，为了测试这样的ON负荷使其和邻近的视网膜和血管变形的假设， 负载使眼睛平移。我们提出，在眼球运动过程中产生的变形可能会产生 导致青光眼、NA-AION和轴性近视的重复性劳损。在受试者组中， 上述疾病，并在一组匹配的健康受试者的平等，我们将研究眼的机械效应 通过光学相干对其内部微观结构和血管进行成像，实现活体眼睛内的运动 断层扫描，以及使用MRI在眼球外的眼窝中。在眼球运动过程中， 通过对受到机械损伤的新鲜人眼库标本进行精确的3D光学成像， ON上的张力，其模仿在活体中成像的眼球运动的效果。Aim III将模拟 眼球运动学的生物力学。非肌性眼的本构力学特性&眼 将使用现代工程方法通过有限元模型（FEM）描述牙槽组织， 计算模拟来预测眼部运动学以及ON和巩膜中的局部机械应变 可能导致青光眼、NA-AION和极度近视的眼部畸形。我们将 确定采用正常组织特性的FEM是否可以模拟水平运动过程中的正常眼球平移 &垂直旋转&收敛。通过有限元模拟，我们还将测试假设， 眼球运动可能导致：正常聚散、斜视和斜视手术的影响。

We propose 3 interrelated aims to define the biomechanics of the eye rotating (extraocular) muscles (EOMs) & optic nerve (ON) in health & visual disease, understand novel EOM actions, & characterize mechanical effects that may contribute to severe myopia. We aim to improve treatment of strabismus, misalignment of visual directions of the eyes; glaucoma & non-arteritic anterior ischemic optic neuropathy (NA-AION), both common blinding ON diseases; & high axial myopia, an ocular elongation & distortion that has become a worldwide epidemic & major cause of blindness. We propose a novel & critical nexus linking the EOMs, ON, & structure of the eye's scleral wall that we will explore using modern imaging & artificial intelligence techniques. Aim I will clarify the kinematic (motion) properties of the human eye, testing by multipositional magnetic resonance imaging (MRI) of the eyeball & EOMs the hypothesis that translational (linear) movement contributes importantly to ocular alignment. MRI will be performed during horizontal convergence & vertical eye rotation in normal people, & in patients who have common forms of strabismus including convergence insufficiency, eye crossing (esotropia), & outward ocular deviation (exotropia), both before & after corrective EOM surgery. Clarification of ocular translation is necessary to understand normal ocular motility and treat its disorders. Aim II will characterize the mechanical loading on the ON caused by eye movements. We will characterize the mechanical effects of ON tractional loading on the eyeball during horizontal & vertical eye rotations at 2 scales in living people, to test the hypothesis that such ON loading deforms it & adjacent retina & blood vessels as loading translates the eye. We propose that the resulting deformation during eye movements may create repetitive strain injury contributing to glaucoma, NA-AION, & axial myopia. In groups of subjects with the foregoing diseases, & in an equal group of matched healthy subjects, we will study mechanical effects of eye movement within the living eye by imaging its internal micro structure & blood vessels with optical coherence tomography, & outside the eyeball in the eye socket using MRI. Effects of tethering during eye movement will be studied ex vivo by precision 3D optical imaging of fresh human eye bank specimens subjected to mechanical tension on the ON that mimic effects of the eye movements imaged in the living subjects. Aim III will model the biomechanics of ocular kinematics. The constitutive mechanical properties of the non-muscular ocular & eye socket tissues will be described by finite element models (FEMs) using modern engineering methods for computational simulation to predict ocular kinematics, as well as local mechanical strains in the ON & sclera that may cause glaucoma, NA-AION, & the ocular deformities underlying extreme nearsightedness. We will determine if FEMs employing normal tissue properties can simulate normal ocular translation during horizontal & vertical rotations & convergence. By FEM simulation, we will also test the hypothesis that ocular loading by eye movement might contribute to: normal vergence, strabismus, & the effects of strabismus surgery.