BIOMECHANICAL ANALYSIS IN STRABISMUS SURGERY

描述：（研究者摘要）：显著性。 斜视- 视轴错位-影响约3%的人口， 视觉障碍的一个重要原因，如复视，弱视， 立体视盲 无论病因是中枢性还是眼眶性，明确的 斜视的治疗通常是外科手术。 然而，准确性 手术治疗仍然低得令人不安：20 - 50%的病例需要 多次手术，每次手术都使患者面临额外的发病率， 开销. 一个经过验证的眼部静态力学计算模型将 改进诊断和治疗计划，但由于 缺乏一致的临床基础科学合作， 发展 这种模式还将促进对核心问题的基础研究。 或神经性斜视的原因， 疾病状态、手术操作和愈合的组成部分 流程. 目的和方法。 "SQUINT"计算生物力学 双目对准模型是描述静态 球体和眼眶组织的平衡，作为计算机实现 程序. 我们建议开发，测试和应用SQUINT模型。 该模型的开发将包括（a）消除现有的 假设通过实施地球仪 平移力平衡约束，以及（B）结合新颖的 治疗以前被忽视的眼眶结缔组织的作用， 根据我们之前的三维磁共振成像（MRI） 眼外肌通路与眼外肌功能关系的研究 地球仪。 我们将进一步寻找结缔组织“滑轮”的证据， 一项新的核磁共振成像研究， 紧张结缔组织：各种Duane退缩综合征，以及 用不同的手术技术进行肌肉移位手术。 这些研究将允许非侵入性，定量测定 以前不可及的结缔组织的机械性能。 我们 将开发和前瞻性地测试模型使用广泛的前， 术后Hess测试双眼对准数据，扫视轨迹 测量、术中机械测量和MRI数据， 专门为此目的收集的。 我们将应用该模型进行研究 对术后愈合对线的影响， 结合术后纵向数据，推断眼眶和神经支配 变化

DESCRIPTION: (Investigator's abstract): 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. Whether the cause is central or orbital, definitive therapy for strabismus is usually surgical. Nevertheless, accuracy of surgical treatment remains disappointingly low: 20-50% of cases require multiple surgeries, each exposing patients to additional morbidity and expense. A validated computational model of ocular static mechanics would improve diagnosis and treatment planning, and yet has been elusive, due to absence of a concerted clinical-basic science collaboration devoted to its development. Such a model would also facilitate basic research on central or innervational causes of strabismus by allowing isolation of mechanical components of disease states, surgical manipulations, and healing processes. Aims and Methods. The "SQUINT" computational biomechanical model of binocular alignment is a system of equations describing static equilibrium of the globes and orbital tissues, implemented as a computer program. We propose to develop, test, and apply the SQUINT model. Development of the model will include (a) eliminating the existing assumptions regarding reciprocal innervation by implementing globe translation force-balance constraints, and (b) incorporating a novel treatment of the previously-neglected role of orbital connective tissues, suggested by our previous 3-dimensional magnetic resonance imaging (MRI) studies of functional relationships of extra-ocular muscle paths to the globe. We will seek further evidence for connective tissue "pulleys", with new MRI studies of patients with conditions in which muscles abnormally strain connective tissues: varieties of Duane's retraction syndrome, and muscle transposition surgery performed with different surgical techniques. These studies will permit non-invasive, quantitative determination of mechanical properties of previously-inaccessible connective tissues. We will develop and prospectively test the model using extensive pre- and post-operative Hess test binocular alignment data, saccadic trajectory measurements, intra-operative mechanical measurements, and MRI data, collected specifically for this purpose. We will apply the model to study the effects on alignment of post-surgical healing, using it in conjunction with longitudinal post-surgical data, to infer orbital and innervational changes.