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SE Morale, EE Birch; Rapid Achievement of Developmental Milestones Following Early Surgery for Infantile Esotropia . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4680.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Infantile esotropia disrupts normal stereoacuity development, acuity in many nonpreferred eyes, and may be a risk factor for delayed achievement of developmental milestones. Early muscle surgery can improve sensory visual outcomes. Does early muscle surgery also accelerate the rate of motor development post-surgery? The purpose of this study was to examine the rate at which developmental milestones are achieved pre- and post-muscle surgery. Methods: A 25-question developmental milestones survey addressing 10 sensorimotor (score: 0-10) and 15 gross motor skills (score: 0-15), was constructed. To determine validity, 20 randomly selected infants were prompted to perform the tasks by a masked examiner and their abilities were compared to the parental report. The parents of 232 normal infants, 82 pre-surgery esotropia infants and 31 post-surgery infants completed the survey to determine rate of developmental milestones achievement. Results: Overall, comparison of individual survey questions with masked testing showed excellent validity; only 5.8% of 500 responses were discordant. Total scores were highly correlated with performance in the masked test; all questions (r2 = 0.966), sensorimotor (r2 = 0.737) and gross motor (r2 = 0.976). Sensorimotor and gross motor scores of normal infants showed monotonic progression during infancy. Two-way ANOVA with planned comparisons showed pre-surgery esotropia infants had significant deficits in achievement of sensorimotor milestones during the rapid period of development from 4 to 6 months of age (p < 0.05), however, a significant difference in gross motor milestones was shown only at 9 months of age (p = 0.004). Following muscle surgery, sensorimotor and gross motor milestones achievement of esotropia infants showed no significant difference from normal. For 24 infants with pre- and post-surgery data, the rate of sensorimotor achievement just after surgery was greater than normal (t = 3.70, p < 0.01) while gross motor achievement was not significantly different (t = -0.37, p = 0.72). Conclusion: These results suggest that early muscle surgery accelerates the achievement of developmental milestones.
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