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Clinical features and treatment status of antiacetylcholine receptor antibody-positive ocular myasthenia gravis

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To clarify the factors predictive of progression from ocular myasthenia gravis (OMG) to generalized MG (GMG) among patients with positive antiacetylcholine receptor antibodies (AChRAb) and to evaluate the efficacy of our OMG treatment protocol including tacrolimus (TAC).

Study design

Retrospective study.

Methods

Fifty-two patients with AChRAb positivity and ptosis and/or eye movement disturbance showing diurnal fluctuation and fatigability were included. First, we compared the clinical characteristics of patients without OMG progression (p-OMG) with those of patients whose OMG transformed to GMG (TMG). Second, we subdivided the p-OMG patients according to the time of approval of TAC into the Before group and the After group. We compared the dosage and period of prednisolone administration (PSL) of the 2 groups. Third, we evaluated the responses to OMG treatment using the Myasthenia Gravis Foundation of America Postintervention Status (MGFA-PS) scale.

Results

Forty-one patients were classified into the p-OMG group, and 11, into the TMG group. The AChRAb level (P = 0.0006) and prevalence of thymoma (P = 0.001) were significantly higher in the TMG group than in the p-OMG group. In the p-OMG group, the MG composite score (P ≤ 0.0001) and AChRAb level (P = 0.005) improved after treatment. The periods of PSL administration at ≥ 20 mg/day (P = 0.009) and at 10 to 19 mg/day (P = 0.002) were significantly shorter in the After group. At the last follow-up, 78.0% of the p-OMG group patients had achieved MGFA-PS minimal manifestations or better status with PSL ≤ 5 mg/day.

Conclusions

The TMG cases were characterized by higher AChRAb levels and presence of thymoma. The P-OMG patients could be managed with our treatment protocol. Combined use of TAC was efficacious in patients with steroid-dependent p-OMG.

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Authors and Affiliations

  1. Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-850, Japan

    Yoshihiko Isshiki, Osamu Mimura & Fumi Gomi

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  1. Yoshihiko Isshiki
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  2. Osamu Mimura
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  3. Fumi Gomi
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Correspondence to Yoshihiko Isshiki.

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Conflicts of interest

Y. Isshiki, None; O. Mimura, Lecture fee (Santen, Senju, Otsuka, Pfizer, Alcon, GSK); F. Gomi, Grant, Lecture fee (Pfizer, Novartis, Santen, Senju), Grant (Alcon), Lecture fee (Bayer).

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Corresponding Author: Yoshihiko Isshiki

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Isshiki, Y., Mimura, O. & Gomi, F. Clinical features and treatment status of antiacetylcholine receptor antibody-positive ocular myasthenia gravis. Jpn J Ophthalmol 64, 628–634 (2020). https://doi.org/10.1007/s10384-020-00770-z

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  • DOI: https://doi.org/10.1007/s10384-020-00770-z

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