[Treatment of pure ocular myasthenia: a proposal from Japan MG registry 2012]

Area of Science:

• Neurology
• Immunology

Context:

• Autoimmune myasthenia gravis (MG) affects ocular and generalized muscles.
• Ocular myasthenia (OM) specifically impacts extrinsic ocular muscles, presenting diverse symptoms from ptosis to ophthalmoplegia.
• Current evidence for corticosteroid efficacy in OM is limited.

Purpose:

• To investigate treatment strategies for ocular myasthenia (OM) based on symptom presentation (ptosis vs. diplopia).
• To identify factors associated with unfavorable treatment outcomes and quality-of-life (QOL) impairment in OM patients.
• To evaluate the effectiveness of prednisolone (PSL) and immunosuppressants in OM management.

Summary:

• A study of 123 OM patients (≥2 years duration) divided into ptosis-alone (n=36) and diplopia-with/without-ptosis (n=87) groups.
• Prednisolone (PSL) and immunosuppressants were less utilized in the ptosis group; no significant differences in post-treatment status or QOL were found between groups.
• Thirty-eight percent of patients on PSL ≤5 mg/day (unfavorable condition) experienced severe QOL impairment, with Ocular-QMG score being a significant factor.

Impact:

• Highlights the need for distinct treatment approaches for ptosis-dominant versus diplopia-dominant OM.
• Identifies Ocular-QMG score as a predictor of poor treatment response and severe QOL impairment.
• Suggests that tailored treatment strategies are crucial for improving ocular symptoms and QOL in OM patients with unfavorable prognoses.