Clinical Features Of Ocular Myasthenia Gravis In Adult Patients: Diplopia and Ophthalmoplegia

Abstract

Background: The diagnosis of ocular myasthenia gravis (OMG) in adult patients remained challenged and the characteristics of diplopia and ophthalmoplegia in OMG is unclear. Methods: Retrospective case series study of medical records of 40 adult patients diagnosed with OMG at The First Affiliated Hospital of Jinan University from June, 2016 to December, 2019, was performed to analyze the clinical features, diagnostic tests and preferential affected extraocular muscles of OMG. Results: 40 adult patients with OMG were involved and men represented 20 (50%) of cases. Mean age (±SD) among men was 49 ± 21 years (range: 19-81 years) and 40 ± 15 years (range: 21-65 years) among women. 18 patients (45.0%) were 18 to 39 years old, 12 patients (30.0%) were 40 to 59 years old, 9 patients (22.5%) were 60 to 79 years old, 1 patients (2.5%) over 80 years old. The median course of the disease among all the patients was 6 months (ranged: 1 month to 10 years). Neostigmine test was positive in 32 of 40 patients (80.0%), acetycholine receptors antibodies assay was positive in 4 of 40 patients (10.0%), Thymus CT showed abnormal findings in 5 of 40 patients (12.5%). At the first visit, 27 patients (67.5%) showed diplopia only, 9 patients (22.5%) showed ptosis only, 4 patients (10.0%) showed diplopia with ptosis. The most paralytic EOM, determined through light reflection, cover-uncover test and red glass test for patients presented with diplopia only (n=27) and diplopia with ptosis (n=9), was lateral rectus (51.6%), superior rectus (19.4%), medial rectus (12.9%), inferior rectus (9.8%), superior oblique (3.2%), inferior oblique (3.2%) in order. Conclusions: OMG mainly affected adults at the working ages. Diplopia serves as initial symptom in most adult patients with OMG and lateral rectus is most susceptible.

Epidemiologie okulärer Manifestationen bei Autoimmunkrankheiten

“…Die Prävalenz der Myasthenia gravis nimmt zu, wobei die weltweite Prävalenz derzeit auf 20 Personen pro 100 000 Einwohner geschätzt wird [72]. In einer Studie wurde festgestellt, dass bei 82% der untersuchten Patienten eine Augenschwäche das erste Symptom war [73].…”

“…In einer Kohortenstudie von Tang et al wiesen knapp 70% eine Diplopie und 25% eine Ptosis bei der ersten Untersuchung auf. Bei allen 40 Patienten war der seitliche Rektusmuskel betroffen, was zu einer Einschränkung der Augenbewegung führte [73].…”

Epidemiology of Ocular Manifestations in Autoimmune Disease

“…The prevalence of myasthenia gravis is increasing, with global prevalence currently estimated to be 20 people per 100,000 population ( 72 ). Notably, one study found an ocular weakness to be the initial symptom in 82% of patients studied ( 73 ).…”

“…In a cohort study by Tang et al., just under 70% and 25% showed diplopia and ptosis respectively on first evaluation. Of all 40 patients, the lateral rectus muscle was affected, leading to restriction of eye movement ( 73 ).…”