BIOMECHANICAL ANALYSIS IN STRABISMUS SURGERY

意义重大。斜视--视轴的错位--会影响一些 占总人口的3%，是视力障碍的重要原因 如复视、弱视和立体盲。明确的治疗方法 斜视通常是外科手术。尽管如此，手术的准确性 治疗水平仍然低得令人失望：20%-50%的病例需要多次 手术，使患者面临更多的发病率和费用。一个 对眼外肌和眼外肌力学的定量认识 眼眶结缔组织将改善诊断和治疗计划， 然而，这一点一直难以捉摸。这样的理解也将有助于 斜视中枢或神经性病因的基础研究 从而可以隔离机械部件。 目的和方法。我们建议研究眼眶的功能解剖学。 人和猴子的结缔组织和眼外肌。我们会 确定眼外肌大小和收缩能力的人群正常值 使用磁共振成像技术，在不同的人体样本中观察肌肉 (核磁共振)。类似地，我们将描述选定的 斜视患者，重点是上斜肌和外直肌 疾病及其解决的时间进程。我们将描述 人眼眶结缔组织的解剖和连续切片 猴子身体，将人类数据与眼眶核磁共振数据相关联。新鲜的 身体，我们将测量Tenon筋膜及其袖子的硬度， 这些构成了推定的直肌“滑轮”。vbl.使用 组织化学、免疫组织化学和染色技术，然后我们将 发现结缔组织的类型和分布，并平滑 肌肉负责机械性能的测量，以及平滑 肌肉神经支配。我们将把Tenon筋膜的区域拉伸想象为 凝视的一种功能，使用植入训练的放射不透明标记 猴子。在猴子身上，我们将通过外科手术修改Tenon的袖子，以评估 力学效应及加强治疗的途径探讨 移位手术。我们将统一并解释所有调查结果 双目对准的“斜视”生物力学模型--一组方程 描述地球和轨道组织的静态平衡， 以计算机程序的形式实现。我们将开发并进行前瞻性测试 术前、术后广泛的Hess双眼斜视试验 收集的对准数据、扫视测量和MRI数据 特别是为了这个目的。我们将应用该模型来研究对 手术后愈合的对准，与术后联合使用 手术数据，以推断眼眶和神经的变化。

Significance. Strabismus - misalignment of the visual axes - affects some 3% of the population and is a significant cause of visual disturbances such as diplopia, amblyopia, and stereoblindness. Definitive therapy for strabismus is usually surgical. Nevertheless, accuracy of surgical treatment remains disappointingly low: 20-50% of cases require multiple surgeries, exposing patients to additional morbidity and expense. A quantitative understanding of the mechanics of extraocular muscles and orbital connective tissues would improve diagnosis and treatment planning, and yet has been elusive. Such an understanding would also facilitate basic research on central or innervational causes of strabismus by allowing mechanical components to be isolated. Aims and Methods. We propose to study the functional anatomy of orbital connective tissues and extraocular muscles in humans and monkeys. We will determine population norms for size and contractility of extraocular muscles in a diverse sample of humans, using magnetic resonance imaging (MRI). Similarly, we will characterize the pathophysiology of selected strabismic patients, focusing on superior oblique and lateral rectus disorders, and the time courses of their resolution. We will characterize orbital connective tissues by dissecting and serially-sectioning human and monkey cadavers, correlating human data with orbital MRI data. In fresh cadavers, we will measure the stiffness of Tenon's fascia and its sleeves, these constituting putative "pulleys" of the rectus muscles. Using histochemical, immunohistochemical, and dye techniques, we will then discover the types and distribution of connective tissues and smooth muscles responsible for mechanical properties measured, as well as smooth muscle innervation. We will image regional stretching of Tenon's fascia as a function of gaze, using radio-opaque markers implanted in trained monkeys. In monkeys we will surgically modify Tenon's sleeves to evaluate mechanical effects and explore avenues for therapeutic enhancement of transposition surgery. We will unify and interpret all findings using the "SQUINT" biomechanical model of binocular alignment, a system of equations describing static equilibrium of the globes and orbital tissues, implemented as a computer program. We will develop and prospectively test SQUINT using extensive pre- and post-operative Hess test binocular alignment data, saccadic measurements, and MRI data, collected specifically for this purpose. We will apply the model to study effects on alignment of post-surgical healing, using it in conjunction with post- surgical data, to infer orbital and innervational changes.