Predictors of achieving minimal manifestations or better status in ocular myasthenia gravis with immunotherapy

Ocular myasthenia gravis (MG), while less severe than generalized MG, significantly impairs quality of life due to its impact on vision and daily activities. Immunotherapy is a key treatment, yet the optimal timing for initiation remains undefined.

To identify predictive factors for achieving minimal manifestations (MM) or better status in ocular MG patients receiving immunotherapy, with a focus on the role of early intervention.

We conducted a retrospective analysis of 48 ocular MG patients treated at our institution. Patients were categorized based on whether they achieved MM or better status. Clinical variables were analyzed using univariate, receiver-operating characteristic, and multivariate logistic regression analyses.

MM or better status was achieved in 34/48 patients (median onset age: 55 years). Time from symptom onset to immunotherapy initiation was significantly shorter in those who achieved MM or better status (median: 30 days vs. 1095 days; p < 0.001). Receiver-operating characteristic analysis determined a 255-day cutoff for immunotherapy initiation, yielding sensitivity of 92.9% and specificity of 91.2% (AUC = 0.986, 95% CI: 0.962-1.000, p < 0.001). Logistic regression confirmed early immunotherapy as an independent predictor.

Early initiation of immunotherapy (< 255 days from onset) significantly improves the likelihood of achieving MM or better status in ocular MG. These findings support the need for prompt diagnosis and treatment to optimize outcomes.