BIOMECHANICAL ANALYSIS IN STRABISMUS SURGERY

描述(摘自申请者的摘要)：斜视，斜视 在美国很流行，通常用外科手术治疗 结果并不完美。这是一个不充分的范例的可预见的结果 了解眼眶解剖和双眼对齐的生物力学， 有时会导致错误的诊断和手术。这样做的总体目标是 项目是发展一个生理上现实的，定量的理解 眼外肌的生物力学(EOMS)及其相关的连接 负责眼睛运动和对齐的组织，并适用于 这些信息有助于斜视的诊断和治疗。最近的证据 人类和其他灵长类动物的研究表明，眼眶结缔组织形成了 复杂的万向架系统来调节眼球运动学。每个组件的全局层 眼外直肌(EOM)旋转眼睛，而眼眶层 该EOM平移作为EOM的结缔组织滑轮 功能起源。滑轮在正常的生物力学中起着至关重要的作用 对齐。先天性和获得性滑车异常会导致某些类型的 花样斜视和其他可能与操作滑轮有关 斜视手术中的组织。我们提出了一个多学科的方法来 通过平行研究了解双眼对准的机制 人类和猴子。我们将使用磁共振成像(MRI)来获得 EOMS和结缔组织随时间变化的近显微分辨率 正常人和斜视者的凝视方向。我们将测试“ 主动滑轮假说：法线的动态平移位置 滑轮被调节为与眼睛运动行为一致，例如 李斯特眼球扭转定律。我们将研究正常老化状态下的EOM滑轮， 特征形式的斜视变得很普遍。比较 先天性和获得性旋转性垂直斜视的眼眶成像 提供关于皮带轮异位之间因果关系的证据 还有斜视。我们将调查滑轮之间可能的关系 分离性垂直内斜视的异常和两种常见的并存 斜视和下斜肌功能亢进。我们将在人类身上研究 增龄等病理改变对EOM结缔组织结构和功能的影响 EOM的成分、行为和解剖学定义了EOM的关系 本体感觉器官到滑轮。我们将比较正常猴子的滑轮 那些天生的和人为的斜视患者。将对数据进行测试 在适合临床使用的双目对准计算模型中。 研究结果将批判性地评估一种新的、可能更有用的范式 以了解眼球运动和斜视的治疗。

DESCRIPTION (Adapted from applicant's abstract): Strabismus, the misalignment of the eyes, is prevalent in the US and usually treated surgically with imperfect results. This is the predictable result of an inadequate paradigm for understanding orbital anatomy and the biomechanics of binocular alignment, sometimes leading to erroneous diagnoses and surgery. The overall aim of this project is to develop a physiologically realistic, quantitative understanding of the biomechanics of the extraocular muscles (EOMS) and associated connective tissues responsible for the movement and alignment of the eyes, and to apply this information to the diagnosis and treatment of strabismus. Recent evidence in humans and other primates shows that orbital connective tissues form a complex gimbal system to regulate ocular kinematics. The global layer of each rectus extraocular muscle (EOM) rotates the eye, while the orbital layer of that EOM translates the connective tissue pulley that serves as the EOM's functional origin. Pulleys play a crucial role in normal biomechanical alignment. Congenital and acquired abnormalities of pulleys cause some types of pattern strabismus, and others may be related to manipulations of pulley tissues during strabismus surgery. We propose a multidisciplinary approach to understanding the mechanics of binocular alignment through parallel studies in humans and monkeys. We will employ magnetic resonance imaging (MRI) to obtain near-microscopic resolution of EOMs and connective tissues as they change with the direction of gaze in normal and strabismic subjects. We will test "the active pulley hypothesis" that the dynamic translational position of normal pulleys is regulated to be consistent with ocular kinematic behavior such as Listing's Law of ocular torsion. We will study EOM pulleys in normal aging, where characteristic forms of strabismus become prevalent. Comparison of orbital imaging in congenital and acquired cyclovertical strabismus will provide evidence concerning the causal relationship between pulley heterotopy and strabismus. We will investigate the possible relationship between pulley abnormalities and two common co-morbidities of esotropia, dissociated vertical deviation and inferior oblique overaction. We will investigate in humans the effects of aging and other pathology on EOM connective tissue structure and constituents, and behaviorally and anatomically define the relationship of EOM proprioceptive organs to pulleys. We will compare pulleys in normal monkeys with those who are naturally and artificially strabismic. Data will be tested in computational models of binocular alignment suitable for clinical use. Findings will critically evaluate a new and potentially more useful paradigm for the understanding of ocular motility and treatment of strabismus.