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Ocular myasthenia: diagnostic and therapeutic problems
Authors:A. Evoli M.D  P. Tonali  E. Bartoccioni  M. Lo Monaco
Affiliation:Catholic University, Rome, Italy.
Abstract:Forty-eight patients with purely ocular myasthenia were studied. Tensilon test was positive in 46 patients (95%); decremental response from limb muscles was present in 24 patients (50%); anti-AChR antibodies were detected in 20 patients of 44 (45.5%). Twenty-two patients underwent thymectomy, 18 were given corticosteroids, 42 received AChE drugs. At the end of the observation period, 8% of the patients were in remission, 67% were improved, 25% were unchanged. In our experience, the diagnosis of ocular myasthenia relies mainly on clinical data; AChE drugs are not very effective in extrinsic ocular muscles; indications for thymectomy should be restricted to thymoma cases and, perhaps, to patients in the early stages of the disease, within the first year of onset; corticosteroids are effective in most cases, but relapses after withdrawal are not uncommon.
Keywords:ocular myasthenia gravis    anti-acetylcholine receptor antibodies    thymectomy    anticholinesterase drugs    corticosteroids
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