BIOMECHANICAL ANALYSIS IN STRABISMUS SURGERY

意义斜视-视轴错位-影响一些 占人口的3%，是视力障碍的重要原因 例如复视、弱视和立体盲。持续治疗， 斜视通常是外科手术。 然而，手术的准确性 治疗仍然低得令人不安：20-50%的病例需要多次治疗。 手术，使患者面临额外的发病率和费用。一 对眼外肌力学的定量理解， 眼眶结缔组织将改善诊断和治疗计划， 但一直难以捉摸这种理解也将有助于 斜视的中枢或神经病因的基础研究 允许机械部件被隔离。 目的和方法。我们建议对眼眶的功能解剖进行研究 结缔组织和眼外肌。我们将 确定眼外肌的大小和收缩力的人群标准 使用磁共振成像技术， （MRI）。同样，我们将描述所选的 斜视患者，关注上级斜肌和外直肌 疾病，以及它们的解决方案的时间过程。我们将描述 眼眶结缔组织的解剖和连续切片， 猴子尸体，将人类数据与眼眶MRI数据相关联。在新鲜 尸体，我们将测量Tenon筋膜及其袖套的刚度， 这些构成了直肌的假定“滑轮”。 使用 组织化学、免疫组织化学和染色技术，我们将 发现结缔组织和光滑组织的类型和分布 负责测量机械性能的肌肉，以及光滑的 肌肉神经支配我们将对Tenon筋膜的区域拉伸进行成像， 凝视的功能，使用不透射线的标记植入训练有素的 猴子在猴子身上，我们将通过手术修改特农的袖子， 机械效应，并探索治疗增强的途径， 转位手术我们将统一和解释所有的调查结果， “SQUINT”双目对准的生物力学模型，方程组 描述球体和眼眶组织的静态平衡， 实现为计算机程序。我们将开发并前瞻性地测试 使用广泛的术前和术后Hess测试双目镜进行SQUINT 所收集的对准数据、扫视测量和MRI数据 专门为此目的。我们将应用该模型来研究 手术后愈合的对齐，将其与术后 手术数据，以推断眼眶和神经支配的变化。

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.