Biomechanical Analysis in Strabismus Surgery

描述（由申请人提供）：斜视，双眼未对准，是一种常见病，通常手术治疗，效果不佳。这是由于对眼外肌（EOM）神经支配、眼眶解剖和双眼排列的生物力学理解不足而导致的可预测结果，有时会导致错误的诊断和手术。眼眶结缔组织，包括滑轮，形成一个复杂的系统，影响双眼对准和所有眼球运动的运动学。先天性和后天性滑轮异常会导致某些类型的斜视，而其他类型的斜视可能与斜视手术中滑轮的操作有关。我们提出了一个多学科的方法来理解眼运动的机制，通过在人类和动物的平行研究，以及眼外肌拉动方向是如何改变前庭眼反射。我们将采用磁共振成像（MRI）可视化眼外肌和结缔组织，因为它们与注视方向和耳石的影响，在正常和斜视的主题。我们将调查人类耳石依赖性斜视，滑轮疾病，以及新兴的手术操作滑轮以下性能这些功能解剖学的变化。我们将研究滑轮的运动学效应并建立数学模型，包括前庭介导的眼球扭转对眼外直肌牵拉方向的影响，滑轮与地球仪的非插入力耦合，以及滑轮异常对符合Listing定律的影响。我们将采用磁共振成像直接在活体研究后天性和遗传性先天性颅神经病变对眼外肌，眼外肌神经支配和双眼排列的影响。在转基因小鼠的补充实验中，我们将在显微镜下研究眼外肌、结缔组织和导致先天性斜视的突变的神经表型，我们将在人类中进行研究。相关性：该项目旨在澄清对负责保持双眼对齐以实现单一视觉的肌肉和韧带的理解。这一认识将提高诊断和手术治疗的交叉和偏离的眼睛，常见的问题，导致复视和视力丧失。研究还将阐明异常眼球运动、平衡障碍的基本遗传和机械原因，并帮助开发治疗斜视的新兴手术。

DESCRIPTION (provided by applicant): Strabismus, binocular misalignment, is prevalent and usually treated surgically with imperfect outcomes. This is the predictable result of inadequate understanding of extraocular muscle (EOM) innervation, orbital anatomy, and the biomechanics of binocular alignment, sometimes leading to erroneous diagnoses and surgery. Orbital connective tissues, including pulleys, form a complex system influencing binocular alignment and kinematics of all eye movements. Congenital and acquired pulley abnormalities cause some types of strabismus, and others may be related to manipulations of pulleys during strabismus surgery. We propose a multidisciplinary approach to understanding the mechanics of eye movement through parallel studies in humans and animals, and how EOM pulling directions are altered by vestibulo-ocular reflexes. We will employ magnetic resonance imaging (MRI) to visualize EOMs and connective tissues as they change with gaze direction and otolith influences in normal and strabismic subjects. We will investigate in humans these functional anatomical changes in otolith-dependent strabismus, pulley disorders, and following performance of emerging surgical manipulations of pulleys. We will investigate and mathematically model the kinematic effects of pulleys, including effects of vestibularly-mediated eye torsion on rectus EOM pulling directions, non-insertional force coupling from pulleys to the globe, and effects of pulley abnormalities on conformity to Listing's Law. We will employ MRI to study directly in living humans the effects of acquired and genetically characterized congenital cranial neuropathies on EOMs, EOM innervation, and binocular alignment. In complimentary experiments in genetically modified mice, we will microscopically study EOM, connective tissues, and nerve phenotypes of mutations causing the congenital forms of strabismus we will investigate in humans. Relevance: This project aims to clarify understanding of muscles and ligaments responsible for keeping the two eyes aligned for single vision. This understanding will improve diagnosis and surgical treatment of crossed and deviated eyes, common problems leading to double vision and visual loss. Studies will also clarify basic genetic and mechanical causes of abnormal eye movements, balance disorders, and aid development of newly-emerging surgeries for treating strabismus.