Topical naphazoline in the treatment of myasthenic blepharoptosis

Nagane, Yuriko; Utsugisawa, Kimiaki; Suzuki, Shigeaki; Masuda, Masayuki; Shimizu, Yuko; Utsumi, Hiroya; Uchiyama, Shinichiro; Suzuki, Norihiro

doi:10.1002/mus.22002

Cited by 14 publications

(9 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Naphazoline, a primary α2-agonist, selectively increases the tone of Muller muscles without mydriasis and successfully reduces myasthenic ptosis [20]. Although rapid effects of topical naphazoline without significant adverse effects were observed in 70% of the MG patients in a previous study, their responses were variable and temporary [20]. In cases of long-standing and irreversible ptosis, surgery for ptosis may be considered [21].…”

Section: Discussionmentioning

confidence: 99%

Quality of life in purely ocular myasthenia in Japan

et al. 2014

Self Cite

View full text Add to dashboard Cite

BackgroundSince there has been no conclusive evidence regarding the treatment of ocular myasthenia, treatment guidelines were recently issued by the European Federation of Neurological Societies/European Neurological Society (EFNS/ENS). However, the therapeutic outcomes concerning the quality-of-life (QOL) of patients with ocular myasthenia are not yet fully understood.MethodsWe investigated the therapeutic outcomes of patients with purely ocular myasthenia in a multicenter cross-sectional survey in Japan. To evaluate the severity of ocular symptoms, we used the ocular-quantitative MG (QMG) score advocated by Myasthenia Gravis Foundation of America. We used the Japanese translated version of the MG-QOL15, a self-appraised scoring system.ResultsOf 607 myasthenia gravis (MG) patients with an observation-duration of illness ≥ 2 years, the cases of 123 patients (20%) were limited to ocular muscles (purely ocular myasthenia). During the entire clinical course, 81 patients experienced both ptosis and diplopia, 36 had ptosis alone, and six had diplopia alone. Acetyl-cholinesterase inhibitors and prednisolone were used in 98 and 52 patients, respectively. Treatment improved ocular symptoms, with the mean reduction in ocular-QMG score of 2.3 ± 1.8 points. However, 47 patients (38%) failed to gain minimal manifestation or a better status. Patients with unfavorable outcomes also self-reported severe QOL impairment. Multivariate analyses showed that the pretreatment ocular-QMG score was associated with unfavorable outcomes, but not associated with the patient’s QOL.ConclusionA treatment strategy designed in accord with a patient's ocular presentation must be considered in order to improve ocular symptoms and the patient's QOL.

show abstract

Section: Discussionmentioning

confidence: 99%

Quality of life in purely ocular myasthenia in Japan

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

“…73 One recent multicenter joint study reported 71.7% usefulness of naphazoline eye drops against eyelid ptosis in 60 MG patients. 73 If eyelid ptosis does not respond to treatment and persists, surgery might be able to repair eyelid function and appearance. There are few studies on the long-term course after surgery or with large sample sizes, but surgery should yield good therapeutic effects as long as the case selection, timing, procedure and surgeon are all appropriate.…”

Section: Recommendationsmentioning

confidence: 99%

“…Eye drops of the α 2 ‐adrenoceptor stimulant, naphazoline, strengthen contraction of Müller's muscle, thereby improving some muscle disorders and eyelid ptosis resulting from partial Horner syndrome . One recent multicenter joint study reported 71.7% usefulness of naphazoline eye drops against eyelid ptosis in 60 MG patients …”

Section: Treatment Strategies For Ocular Mgmentioning

confidence: 99%

Japanese clinical guidelines for myasthenia gravis: Putting into practice

Murai

2015

Clinical & Exp Neuroim

View full text Add to dashboard Cite

Treatment of myasthenia gravis has depended largely on high‐dose corticosteroids for decades. Although this procedure remarkably reduced the mortality rate of myasthenia gravis, it highlighted issues such as the adverse‐effects of steroids and reduction in quality of life. With the recent discovery of novel autoantibodies, a numbers of alternative therapeutic options have become available. The new Japanese clinical guidelines for myasthenia gravis were published in 2014, and they proposed a novel treatment strategy utilizing these therapeutic options, which might replace high‐dose steroids. They also proposed a draft of new diagnostic criteria. The present review introduces the essence of these guidelines and shares the fundamental philosophy of the treatments that value the patients' quality of life.

show abstract

“…Moreover, while corticosteroids are very effective in the short term, long-term adverse effects occur in up to 38% of cases 11,12. Thus, neurologists often struggle to treat patients with medically refractory longstanding blepharoptosis 13–15…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment for medically refractory myasthenic blepharoptosis

Shimizu¹,

Suzuki²,

Nagasao³

et al. 2014

OPTH

Self Cite

View full text Add to dashboard Cite

PurposeCurrently, only a few reports have recommended surgery as a suitable treatment for blepharoptosis associated with myasthenia gravis. The present study aims to introduce our surgical criteria, surgical options, outcomes, and precautions for medically refractory myasthenic blepharoptosis.Patients and methodsEight patients who failed to respond to at least 2 years of medical treatment and who underwent blepharoptosis surgery, from January 2008 to December 2011, were enrolled in this study. Medical records, photographs, and questionnaire results regarding postoperative status were evaluated. Of the eleven procedures performed, four involved frontal suspension, four involved external levator advancement, one involved nonincisional transconjunctival levator advancement, and two involved subbrow blepharoplasty with orbicularis oculi muscle tucking. The margin reflex distance improved postoperatively in seven patients.ResultsSeven patients had very minimal scarring, and one had minimal scarring. Five patients showed no eyelid asymmetry, one had subtle asymmetry, and two had obvious asymmetry. Seven patients were very satisfied, and one patient was satisfied with the overall result. Postoperative complications included mild lid lag with incomplete eyelid closure, prolonged scar redness, and worsened heterophoria. No patient experienced postoperative exposure keratitis or recurrent blepharoptosis during the study period.ConclusionOur results indicate that blepharoptosis surgery is effective for patients with myasthenia gravis, especially those with residual blepharoptosis despite multiple sessions of medical treatments. We recommend that neurologists and surgeons collaborate more systematically and discuss comprehensive treatment plans to increase the quality of life for patients with myasthenia gravis.

show abstract

Topical naphazoline in the treatment of myasthenic blepharoptosis

Abstract: Topical naphazoline was found to be an effective supplementary symptomatic treatment for myasthenic blepharoptosis.

Cited by 14 publications

References 10 publications

Quality of life in purely ocular myasthenia in Japan

Quality of life in purely ocular myasthenia in Japan

Japanese clinical guidelines for myasthenia gravis: Putting into practice

Surgical treatment for medically refractory myasthenic blepharoptosis

Contact Info

Product

Resources

About