Strabismus surgery and long-term visual outcomes in patients with preadolescent onset ocular myasthenia gravis

To investigate long-term strabismus surgical outcomes and visual prognosis in preadolescent ocular myasthenia gravis (OMG).

The medical records of all patients with preadolescent onset OMG who underwent strabismus surgery were reviewed. Thirteen patients met the study inclusion criteria. The main outcomes, including ocular alignment, number of surgeries, and visual acuity at final visit were evaluated. Outcomes were considered successful if there were ≤10 prism diopters (PD) residual horizontal and ≤4 PD residual vertical deviations at final recorded visit.

Among 13 patients, diplopia presented in 11 patients (77.8%). Mean age at disease onset was 5.8 ± 2.7 years (range 1 ∼ 11), mean age at surgery was 20.5 ± 11.3 years (range, 2.5 to 36.6 years), and the time from disease onset to first operation was 14.8 ± 9.6 years (range, 1.5 to 29.6 years). The average length of postoperative follow-up was 4.7 ± 6.6 years (range, 0.5 to 18.9 years). Ocular deviation changed more than 15 PD during stable disease in six patients (46.2%). No patients underwent more than two surgeries. Successful results were achieved in nine patients (69.2%) at final recorded visit.

In our series, nine patients (69.2%) with OMG could obtain good binocular alignment at final visit. Therefore, strabismus surgery can be considered in patients with preadolescent onset OMG who have constant angle of deviation despite medical treatment.