Biomechanical Analysis in Strabismus Surgery

我们提出了三个相互关联的目标来定义眼睛旋转(眼外)肌肉的生物力学。 视神经(ON)在健康和视觉疾病中的作用，了解新的EOM动作，并表征机械效应 这可能会导致严重近视。我们的目标是改进斜视、视觉错位的治疗 眼睛的方向；青光眼和非动脉炎性前部缺血性视神经病变(NA-AION)，两者都很常见 疾病致盲；和高度轴性近视，一种眼球延长和变形，已成为世界性的 流行病&致盲的主要原因。我们提出了一种新的关键关系，将EOMS、ON和结构联系起来 我们将使用现代成像和人工智能技术来探索眼睛的巩膜壁。我会瞄准的 通过多位置磁共振测试，阐明人眼的运动学(运动)特性 眼球成像(MRI)&EOMS平移(直线)运动对眼球运动有重要贡献的假说 到眼球对准。在正常情况下，将在水平会聚和垂直眼球旋转期间进行MRI检查 人&患有常见形式斜视的患者，包括会聚功能不全、交叉眼球 (内斜视)和外斜视(外斜视)，包括矫正EOM手术前后。澄清 眼球平移对于了解正常的眼球运动和治疗眼球运动障碍是必要的。AIM II将 描述眼球运动对眼球运动造成的机械负荷。我们将描述 两种尺度水平和垂直眼球旋转时牵引力对眼球的力学影响 在活人身上，为了检验这样的负荷会使它及其邻近的视网膜和血管变形的假设 装货是眼睛的翻译。我们认为，眼球运动过程中产生的变形可能会导致 反复劳损会导致青光眼、鼻窦炎和轴性近视。在受试者组中， 前述疾病&在一组匹配的健康受试者中，我们将研究眼睛的机械效应 通过光学相干成像活体眼睛的内部微结构和血管的运动 断层扫描，使用核磁共振技术在眼球外面的眼窝中进行。眼球运动时系绳的影响将 机械作用下新鲜人眼库标本的精密三维光学成像体外研究 在模拟活体受试者眼球运动的效果的基础上进行的紧张。AIM III将为 眼运动学的生物力学。非肌肉型眼球的本构力学特性 眼窝组织将由有限元模型(FEMS)描述，使用现代工程方法 预测眼球运动学以及巩膜上局部机械应变的计算机模拟 这可能会导致青光眼，NAAION，这是导致极度近视的眼睛畸形。我们会 确定采用正常组织特性的FEMS是否可以模拟水平过程中的正常眼球平移 &垂直旋转和收敛。通过有限元模拟，我们还将检验眼球负荷通过 眼球运动可能有助于：正常的正视、斜视和斜视手术的效果。

We propose 3 interrelated aims to define the biomechanics of the eye rotating (extraocular) muscles (EOMs) & optic nerve (ON) in health & visual disease, understand novel EOM actions, & characterize mechanical effects that may contribute to severe myopia. We aim to improve treatment of strabismus, misalignment of visual directions of the eyes; glaucoma & non-arteritic anterior ischemic optic neuropathy (NA-AION), both common blinding ON diseases; & high axial myopia, an ocular elongation & distortion that has become a worldwide epidemic & major cause of blindness. We propose a novel & critical nexus linking the EOMs, ON, & structure of the eye's scleral wall that we will explore using modern imaging & artificial intelligence techniques. Aim I will clarify the kinematic (motion) properties of the human eye, testing by multipositional magnetic resonance imaging (MRI) of the eyeball & EOMs the hypothesis that translational (linear) movement contributes importantly to ocular alignment. MRI will be performed during horizontal convergence & vertical eye rotation in normal people, & in patients who have common forms of strabismus including convergence insufficiency, eye crossing (esotropia), & outward ocular deviation (exotropia), both before & after corrective EOM surgery. Clarification of ocular translation is necessary to understand normal ocular motility and treat its disorders. Aim II will characterize the mechanical loading on the ON caused by eye movements. We will characterize the mechanical effects of ON tractional loading on the eyeball during horizontal & vertical eye rotations at 2 scales in living people, to test the hypothesis that such ON loading deforms it & adjacent retina & blood vessels as loading translates the eye. We propose that the resulting deformation during eye movements may create repetitive strain injury contributing to glaucoma, NA-AION, & axial myopia. In groups of subjects with the foregoing diseases, & in an equal group of matched healthy subjects, we will study mechanical effects of eye movement within the living eye by imaging its internal micro structure & blood vessels with optical coherence tomography, & outside the eyeball in the eye socket using MRI. Effects of tethering during eye movement will be studied ex vivo by precision 3D optical imaging of fresh human eye bank specimens subjected to mechanical tension on the ON that mimic effects of the eye movements imaged in the living subjects. Aim III will model the biomechanics of ocular kinematics. The constitutive mechanical properties of the non-muscular ocular & eye socket tissues will be described by finite element models (FEMs) using modern engineering methods for computational simulation to predict ocular kinematics, as well as local mechanical strains in the ON & sclera that may cause glaucoma, NA-AION, & the ocular deformities underlying extreme nearsightedness. We will determine if FEMs employing normal tissue properties can simulate normal ocular translation during horizontal & vertical rotations & convergence. By FEM simulation, we will also test the hypothesis that ocular loading by eye movement might contribute to: normal vergence, strabismus, & the effects of strabismus surgery.