BIOMECHANICAL ANALYSIS IN STRABISMUS SURGERY

描述（改编自申请人摘要）：斜视，未对准 在美国很普遍，通常通过手术治疗， 不完美的结果。这是一个不适当的范例的可预见的结果， 了解眼眶解剖学和双眼排列的生物力学， 有时会导致误诊和手术。其总体目标是 项目是发展一个生理上现实的，定量的理解 眼外肌（EOMS）和相关结缔组织的生物力学 负责眼睛运动和排列的组织，并应用 这些信息对斜视的诊断和治疗有重要意义。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一个 复杂的万向节系统来调节眼睛的运动学。每一个的全局层 眼外直肌（EOM）旋转眼睛，而眶层 眼外肌平移结缔组织滑轮， 功能性起源滑轮在正常的生物力学中起着至关重要的作用， 对齐。滑轮的先天性和后天性异常会导致某些类型的 模式斜视，以及其他可能与操纵滑轮 斜视手术期间的组织。我们提出了一个多学科的方法， 通过平行研究了解双目对准的机制， 人类和猴子我们将使用磁共振成像（MRI）来获得 眼外肌和结缔组织的近显微镜分辨率，因为它们随着 正常人和斜视患者的注视方向。我们将测试“ 主动滑轮假说”，即正常的动态平移位置 调节滑轮以与眼睛运动学行为一致， Listing's Law of ocular torsion眼球扭转定律我们将研究正常老化的EOM滑轮， 在那里斜视的特征形式变得普遍。比较 先天性和后天性旋转垂直斜视的眼眶成像将 提供关于滑轮异位症之间因果关系的证据 和斜视我们将调查滑轮之间的可能关系 异常和两种常见的内斜视合并症，分离性垂直 偏斜和下斜肌功能亢进。我们将在人类中研究 老化和其他病理学对眼外肌结缔组织结构的影响， 成分，并从行为和解剖学上定义EOM的关系 本体感受器官到滑轮。我们将比较正常猴子的滑轮 和那些天生或人工斜视的人一起。将对数据进行测试 在适合临床使用的双目对准的计算模型中。 调查结果将批判性地评估一个新的和潜在的更有用的范例 对于理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.