Development of Generalized Disease at 2 Years in Patients With Ocular Myasthenia Gravis

Abstract

At 2 years, prednisone treatment appears to reduce the incidence of generalized myasthenia gravis to 7% in contrast to 36% of patients who did not receive prednisone. Thymoma, although uncommon, occurs in ocular myasthenia gravis. Only small amounts of edrophonium are needed to diagnose ocular myasthenia gravis.

Prognosis of ocular myasthenia in Korea: A retrospective multicenter analysis of 202 patients

“…Using proportional hazards regression model, this investigation also supports the conclusions of previously published data that the presence of abnormal AChR antibody and thymoma may be risk factors for the development of secondary generalization [4,7]. Intriguingly, however, the prognosis of OMG seems to be much better in our patients with the rate of secondary generalization being approximately half of that reported in Caucasians [2,3].…”

“…Finally, the low rate of secondary generalization could be explained by the early corticosteroid treatment which was given to about one-third of our patients. Indeed, the point estimates of hazard ratios in this investigation (0.24) were comparable to the figures (0.19-0.32) reported in earlier studies [4,7,8], supporting the hypothesis that early corticosteroid treatment can reduce the risk of generalization. However, it should be pointed out that the corticosteroid therapy may simply provide symptomatic control and mask overt evidence of generalization in patients on treatment.…”

“…First of all, the prevalence of OMG was very similar to those reported in earlier studies with approximately 50% of our patients presenting with solely ocular disturbances [3,4]. In addition, the current study adds to the increasing body of evidence that shows a beneficial effect of early corticosteroid treatment on the risk of secondary generalization [4][5][6][7][8].…”

“…Previous studies have reported that ocular disturbances are the first and sole manifestation of MG in about 50% of patients and that between 50% and 60% of patients presenting with OMG subsequently progress to develop generalized disease, usually within the first 1 to 2 years [2,3]. Early immunosuppressive therapy, specifically corticosteroids and/or azathioprine, has been suggested to prevent or delay the secondary generalization [4][5][6][7][8], but the cost-to-benefit ratio of this treatment remains controversial with no randomized controlled study conducted thus far [9]. Only a few studies have addressed the prognostic factors for OMG [2,4], and several clinical and laboratory factors, such as older age at onset, presence of anti-acetylcholine receptor (AChR) antibody, high antibody titers, and the presence of thymoma, were claimed to be associated with an increased risk of secondary generalization.…”

Ocular Myasthenia: Clinical Features and Diagnosis

“…Approximately, half of MG patients who present with ocular manifestation develop generalized disease within 6 months and up to 80% will generalize within 2 years [6]. In contrast, OMG presenting in children is less likely to progress to generalization.…”