Blepharoptosis surgery in patients with myasthenia gravis

Litwin, Andre; Patel, Bhupendra C.; McNab, Alan A.; McCann, John D.; Leatherbarrow, Brian; Malhotra, Raman

doi:10.1136/bjophthalmol-2014-306335

Cited by 19 publications

(9 citation statements)

References 21 publications

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“…External levator advancement, frontalis slings and tarsomyectomy are the procedures performed. As the aim of surgery is not aesthetic, undercorrection of ptosis is normally practiced to avoid complications such as lagopthalmos and exposure keratopathy (Bradley, Bartley, Chapman, & Waller, 2001;Litwin et al, 2015). Litwin et al in their review of 23 patients underwent ptosis correction surgery showed 87% of ptosis were corrected after one procedure at the final follow up of 29 months (Litwin et al, 2015).…”

Section: Ijphcsmentioning

confidence: 99%

“…As the aim of surgery is not aesthetic, undercorrection of ptosis is normally practiced to avoid complications such as lagopthalmos and exposure keratopathy (Bradley, Bartley, Chapman, & Waller, 2001;Litwin et al, 2015). Litwin et al in their review of 23 patients underwent ptosis correction surgery showed 87% of ptosis were corrected after one procedure at the final follow up of 29 months (Litwin et al, 2015). Seventeen percent of the patients needed to undergo second procedure because the first operation was complicated with exposure keratopathy (Litwin et al, 2015).…”

Section: Ijphcsmentioning

confidence: 99%

“…Litwin et al in their review of 23 patients underwent ptosis correction surgery showed 87% of ptosis were corrected after one procedure at the final follow up of 29 months (Litwin et al, 2015). Seventeen percent of the patients needed to undergo second procedure because the first operation was complicated with exposure keratopathy (Litwin et al, 2015). Other complications that may be associated with ptosis surgery are worsened diplopia and recurrent ptosis (Bradley et al, 2001;Litwin et al, 2015).…”

Section: Ijphcsmentioning

confidence: 99%

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A Typical Case of Childhood Ocular Myasthenia Gravis: A Literature Review From Ophthalmology Perspective

Azhan

Zunaina

Zamli

2018

IJPHCS

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Background: Childhood ocular myasthenia gravis (MG) is a rare autoimmune disease that has a benign course and provide a good overall prognosis. Diagnosis of ocular MG especially in children is often difficult especially in younger age group as the symptoms may be subtle and may mimic other pathology. There are many articles discussing MG in general, but only a handful elaborating on childhood ocular MG. This article is discussing a typical case of childhood MG and a review of current clinical approach particularly from ophthalmology point of view. Case Report: A one-year-old Malay girl who was previously well, presented with 2 weeks history of left eye ptosis and intermittent exotropia following a brief episode of fever. A provisional diagnosis of ocular MG was made. Unfortunately, the patient defaulted pediatric neurology follow up for confirmatory investigations. She came back 2 years later with bilateral ptosis. Upon her second presentation, blood investigation for acetylcholine receptor antibody showed positive result and finally she was diagnosed to have ocular MG. She was co-managed with a pediatric neurologist and was treated with oral pyridostigmine. Satisfactory improvement of ptosis was achieved with no amblyopia. There was no features of systemic MG during 2 years follow up. Conclusion: Although this is a typical presentation of childhood ocular MG, there are many interesting and useful learning points particularly from an ophthalmology point of view.

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Section: Ijphcsmentioning

confidence: 99%

Section: Ijphcsmentioning

confidence: 99%

Section: Ijphcsmentioning

confidence: 99%

See 1 more Smart Citation

A Typical Case of Childhood Ocular Myasthenia Gravis: A Literature Review From Ophthalmology Perspective

Azhan

Zunaina

Zamli

2018

IJPHCS

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“…A Japanese series found that seven of eight patients who underwent lid‐elevation procedures for treatment‐resistant myasthenic ptosis, present for at least 2 years and with minimal circadian changes, were satisfied with the outcome . The Mayo clinic described nine patients who underwent surgery for treatment‐refractory ptosis after trying MG therapies for at least 12 months; half of their cases required additional procedures owing to undercorrection of ptosis, but this is preferable to overcorrection and secondary‐exposure keratitis …”

Section: Managing the Disability Of Op‐mgmentioning

confidence: 99%

A unique subphenotype of myasthenia gravis

Heckmann

Nel

2017

Annals of the New York Academy of Sciences

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While extraocular muscles (EOMs) are affected early in generalized myasthenia gravis (MG), and their treatment responsiveness is similar to nonocular muscles, we have identified an ophthalmoplegic (OP) subphenotype that remains resistant to treatment. This subphenotype of ophthalmoplegic MG (OP-MG) most commonly affects acetylcholine receptor antibody-positive cases with juvenile-onset MG and African genetic ancestry. However, a few OP-MG cases have been found with MuSK antibodies and triple-seronegative MG. In a proportion of OP-MG cases, the EOM treatment resistance manifests from treatment initiation, while in others the EOMs may initially respond until a critical trigger, such as treatment interruption or crisis. The management of OP-MG is an unmet need. Managing the visual disability may require a surgical or nonsurgical solution. The ideal case selection for surgery and the timing of surgery should be carefully considered. The pathogenesis of OP-MG remains unknown. A genetic study, using extended whole-exome sequencing and an "extreme" phenotype sample of OP-MG versus control MG cases differing only by their EOM responsivity to therapy, discovered several potentially functional OP-MG risk variants. These variants implicate myogenesis and gangliosphingolipid biosynthesis pathways at the EOM endplates in OP-MG.

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“…Lesions of the III cranial pair and Horner's syndrome are of neurogenic origin. Myasthenia gravis, a motor plaque disorder, is classified as of myogenic origin 3 . Direct trauma to the eyes 4 , ophthalmologic surgeries in which retractors are used to injure or disengage the aponeurosis 5 , craniofacial surgeries, and those of involutional or senile origin 6 are of aponeurotic causes.…”

Section: Introductionmentioning

confidence: 99%