Effect of early immunotherapy in preventing conversion of ocular myasthenia gravis to generalized myasthenia gravis / 西安交通大学学报(医学版)

【Objective】 To compare the risk of generalization in patients with ocular myasthenia gravis (OMG) receiving or not receiving immunosuppressive treatment. 【Methods】 The data of patients with OMG registered in Tangdu Hospital of Air Force Military Medical University from January 1, 2015 to May 1, 2019 were reviewed; the patients were divided into treatment group and control group according to whether they had received immunosuppressive treatment. The multivariate Cox proportional hazards regression model analysis was used to compare the risk of generalization between the two groups of patients within 2 years of onset. Sensitivity analysis was used to evaluate the duration of immunosuppressive treatment and the risk of generalization under different immunotherapy regimens. By using stratified analysis, the consistency of the main results across different levels of subgroup factors was evaluated. 【Results】 A total of 702 OMG patients were collected. Of them 367 patients (52.3%) were included in the treatment group, with an average onset age of (50.54±15.1) years, and 159 (43.3%) being female. Another 335 patients (47.7%) were included in the control group, with an average age of (49.1±14.6) years, and 159 ones (47.5%) were female. A total of 28 cases (7.7%) in the treatment group and 106 cases (31.6%) in the control group developed generalization during the observation period. After multivariate-adjusted Cox model analysis, patients who had received immunosuppressive treatment had a significantly lower risk of generalization compared with the control group (HR=0.24; 95% CI: 0.15-0.37; P<0.001). Sensitivity analysis found that the longer the duration of immunosuppression, the lower the risk of generalization (HR=0.88; 95% CI: 0.85-0.91; P<0.001). Stratified analysis showed that immunosuppressive therapy reduced the risk of generalization in different subgroups of patients. 【Conclusion】 Early immunosuppressive treatment can significantly reduce the risk of generalization in patients with OMG.

Acupuncture combined with western medication for ocular myasthenia gravis: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between acupuncture combined with western medication and simple western medication for ocular myasthenia gravis (OMG), and to explore its possible mechanism.@*METHODS@#A total of 60 patients of ocular myasthenia gravis were randomized into an acupuncture combined with western medication group (30 cases, 1 case dropped off) and a western medication group (30 cases, 2 cases dropped off). Oral pyridostigmine bromide tablet and prednisone acetate tablet were given in the western medication group. On the basis of the treatment in the western medication group, Tongdu Tiaoqi acupuncture (acupuncture for unblocking the governor vessel and regulating qi ) was applied at Baihui (GV 20), Fengfu (GV 16), Hegu (LI 4), Zusanli (ST 36), etc. in the acupuncture combined with western medication group, once a day, 6 days a week. The treatment was given 8 weeks in both groups. Before and after treatment, the OMG clinical absolute score was observed, electrophysiological indexes of orbicularis oculi (value of mean jitter, percentage of jitter >55 μs and percentage of blocks) were measured by single-fiber electromyography (SFEMG), serum levels of acetylcholine receptor antibody (AChR-Ab), interferon-gamma (IFN-γ) and interleukin-4 (IL-4) were detected by ELISA method.@*RESULTS@#After treatment, the OMG clinical absolute scores, values of mean jitter, percentages of jitter >55 μs, percentages of blocks and serum levels of AChR-Ab, IFN-γ and IL-4 were decreased compared before treatment in both groups (P<0.05), and those in the acupuncture combined with western medication group were lower than the western medication group (P<0.05).@*CONCLUSION@#Acupuncture combined with western medication can effectively improve ptosis, palpebra superior fatigability, eye movement disorder and neuromuscular junction dysfunction in patients with ocular myasthenia gravis, the therapeutic effect is superior to simple western medication. Its mechanism may be related to down-regulating serum levels of AChR-Ab, IFN-γ and IL-4 and promoting the recovery of orbicularis oculi function.

Related factors of ophthalmoplegia in children with ocular myasthenia gravis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the related-factors analysis of extra-ocular muscle paralysis in pediatric ocular myasthenia gravis(OMG). <p>METHODS: A retrospective, observational cohort study was performed of 203 pediatric patients diagnosed with OMG between Nov.2011 and May 2020 at Wuhan Children's Hospital. Data on clinical features and laboratory indicators of children with OMG were statistically analyzed between extra-ocular muscle paralysis group and non-extra-ocular muscle paralysis group, which were classified by pediatric ophthalmologists based on ocular manifestations. The Logistic regression analysis was performed immediately after that to determine the independent factors. <p>RESULTS: Totally 203 pediatric OMG, 97(47.8%)had extra-ocular muscle paralysis with various clinical features including strabismus(<i>n</i>=69, 71.1%), torticollis(<i>n</i>=18, 18.6%). Among the 97 children, 79(81.4%)patients were presented with monocular involvement, of which 53(54.6%)had single extra-ocular muscle paralysis. The most common was medial rectus muscle(<i>n</i>=19, 35.8%). Between extra-ocular muscle paralysis group and non-extra-ocular muscle paralysis group, there were statistically significant difference(<i>P</i><0.05)in age, serum immunoglobulin M(IgM), serum free triiodothyronine(FT3), serum thyroglobulin, and glucocorticoid combination pyridostigmine bromide therapy(72.2% <i>vs</i> 38.7%). Furthermore, the level of FT3(<i>OR</i>=2.006, 95%<i>CI</i>:<i> </i>1.233-3.263)and glucocorticoid combined treatment(<i>OR</i>=4.328, 95%<i>CI</i>: 1.936-9.677)were the related-factors affecting the extra-ocular muscle paralysis of children with ocular myasthenia gravis. <p>CONCLUSION: Extra-ocular muscle paralysis was the common ocular manifestation in pediatric OMG. Monocular involvement was more common than binocular involvement especially the medial rectus muscle, while diplopia was rare. The level of FT3 can be considered as an important immune indicator to evaluate extra-ocular muscle paralysis in children with ocular myasthenia gravis.

Research Advances in Follicular Regulatory T Cells in Ocular Myasthenia Gravis / 中国医学科学院学报

Myasthenia gravis(MG)is a B cell-mediated,T cell-dependent,complements-involved autoimmune disease.Ocular myasthenia gravis(OMG)is a typical MG,with its symptoms limited to the extraocular muscles.The occurrence and development of a variety of autoimmune diseases including OMG are closely associated with the imbalanced expression of follicular regulatory T cells(Tfr cells).Therefore,Tfr cells may be a new research topic for OMG.

Utility of single fiber electromyography in the differential diagnosis of hyperthyroidism associated with ocular myasthenia gravis and Graves ophthalmopathy / 临床神经病学杂志

Objective To assess the utility of single fiber EMG (SFEMG)in the differential diagnosis of hyperthyroidism associated with ocular myasthenia gravis (OMG)and Graves ophthalmopathy.Methods SFEMG was performed in orbicularis oculi muscle of 2 groups of patients.including 32 patients with hyperthyroidism associated with OMG,and 35 patients with Graves ophthalmopathy.The parameters of SFEMG between different groups were compared.Results The mean jitter was (96.2 ± 23.7),(42.8 ± 12.6)μs in hyperthyroidism associated with OMG and patients with Graves Orbitopathy. M50of the percentage of jitter ＞55 μs was 92% and 5% in the 2 groups respectively.M50of the percentage of block was 25% and 0 in the 2 groups respectively.Fiber density was (1.9 ± 0.4)and (1.7 ± 0.5)in the 2 groups respectively.There was significant difference in those parameters of SFEMG between the patients in 2 groups(t＝15.56,Z＝9.26,Z＝7.35,all P＜0.01).Conclusion SFEMG of orbicularis oculi muscle shows significantly increased jitter and block in hyperthyroidism associated with OMG,which can help to differentiate hyperthyroidism associated with OMG from Graves ophthalmopathy.

Efficacy of Gaze Photographs in Diagnosing Ocular Myasthenia Gravis

BACKGROUND AND PURPOSE: The various tests that are routinely used to diagnose generalized myasthenia gravis, such as the edrophonium test, serum anti-acetylcholine-receptor antibodies (AChR-Ab), and repetitive nerve stimulation (RNS) tests, have lower diagnostic sensitivity in ocular myasthenia gravis (OMG). Diagnosing OMG becomes even more difficult when the clinical symptoms are subtle. There is no gold-standard diagnostic test available for OMG patients, and so this study compared the diagnostic sensitivity of gaze photographs with conventional tests in OMG. METHODS: Records of gaze photographs were available for 25 of 31 consecutive patients diagnosed with OMG. Each patient underwent a neuro-ophthalmologic examination, serum AChR-Ab, RNS, edrophonium test, ice tests, and the acquisition of gaze photographs. The margin reflex distance 1 (MRD1) was measured on each of the gaze photographs, with MRD1 < 2 mm or an interlid MRD1 difference of ≥2 mm on any of the gaze photographs defined as a positive sign of OMG. The diagnostic sensitivities of the tests were assessed. RESULTS: The mean age at onset was 38.5 years (range, 2–76 years), and 13 patients (52%) were men. The diagnostic sensitivities of the RNS test, AChR-Ab test, gaze photographs, and ice test were 56%, 64%, 80%, and 73%, respectively. CONCLUSIONS: The diagnostic sensitivity was higher for gaze photographs than for the other tests applied to OMG patients.

Embarazada con miastenia grave ocular. Reporte de un caso / Pregnant woman with ocular myasthenia gravis. A case report

La miastenia grave es una enfermedad autoinmune de la placa motora del músculo estriado, caracterizada por fatiga y debilidad muscular fluctuante. La prevalencia es aproximadamente de 5 casos por cada 100 000 personas. La paciente reportada presentó síntomas que limitaban la musculatura cercana al ojo. Esta entidad se denomina miastenia grave ocular, su incidencia en el embarazo es infrecuente. Se reportó un caso de una paciente de 23 años de edad, atendida en la Consulta de Infertilidad del municipio Isla de la Juventud. Se consultó el caso con varias especialidades médicas. El nacimiento se produjo por cesárea de urgencia producto de estado fetal intranquilizante y aplicando anestesia regional. Se obtiene bebé sano, con buena puntuación de apgar y buen peso. Durante el puerperio la madre y el recién nacido evolucionaron satisfactoriamente (AU).

Myasthenia gravis is an autoimmune disease of the motor end-plate of the striated muscle, characterized by fluctuant muscular fatigue and weakness. Its prevalence is around 5 cases per 100 000 persons. The reported patient presented symptoms limiting the muscles near the eye. This entity is named ocular myasthenia gravis. Its incidence in pregnancy is infrequent. It is reported the case of a female patient, aged 23 years, attended in the Infertility Consultation of the municipality Isla de la Juventud. The case was consulted with several medical specialties. The delivery was produced by emergency cesarean section, applying regional anesthesia, due to the worrying fetal status. The newborn had good apgar score and weight. Mother and child showed satisfactory evolution during the postpartum period (AU).

Diagnostic value of low-frequency repetitive nerve stimulation in patients with ocular myasthenia gravis / 中国基层医药

Objective To investigate the diagnostic value of low-frequency repetitive nerve stimulation (RNS) in patients with ocular myasthenia gravis(MG).Methods The clinical data of the low-frequency RNS of 54 in-patients with ocular MG were analyzed.Results The positive rate of low-frequency RNS was 53.7％ in 54 patients.The abnormal rate of the facial nerve and the proximal limb nerve was significantly higher than that of low limb distal nerve.The differences were statistically significant(x2 =6.783,P =0.009;x2 =4.167,P =0.041).In all the examined nerves,the abnormal rate of right facial nerve was the highest(46.3％),and the lowest on the ulnar nerve(11.1％).The abnormal rate was statistically significant in all these nerves (x2 =21.995,P =0.001).Conclusion Low-frequency RNS plays an important role in the diagnosis of ocular MG,and the facial nerve should be the first choice in this examination.

Surgical treatment of ocular myasthenia gravis: a clinical analysis of 129 cases / 中华胸心血管外科杂志

Objective Summing up and analyzing outcome and influencing factors following thymectomy in patients with ocular myasthenia gravis tries to provide clinical evidence for an option of the treatment modalities.Methods From May 2007 to November 2014,thymectomy was performed in 129 patients with ocular myasthenia gravis consisting of 110 patients by Video-assisted thoracoscopic surgery(VATS) and 19 by partial sternotomy.Follow-up information was obtained by outpatient visit and telephone contact.The outcome evaluation after thymectomy was classified into full remission,partial remission,unchanged and deteriorated.Statistical analysis was done using x2 test and Cox regression model.Results There was no perioperative death.Seven(5.4％) postoperative complications occurred and cured after treatment.Follow-up was complete in 123 patients(95.3％) and the mean duration of follow-up was 49(range 21-99) months.Surgical outcome revealed full remission in 40 patients,partial remission in 68,unchanged in 9 and deteriorated in 6 patients.Response(full remission and partial remission) rate was 87.8％ and no benefit(unchanged and deteriorated) rate was 12.2％.Four of 6 patients in deteriorated condition progressed into generalized myasthenia gravis(3.3％).The significant difference was noted in 24 months or less of preoperative clinical duration (P =0.004) and thymic hyperplasia (P =0.001) in postoperative pathology among the full remission,partial remission and no benefit group.On the other hand,there was no statistical difference in sex,age,symptoms,comorbidities,preoperative taking acetylcholinase inhibitor,corticosteroid,surgical approach,and associated thymona among the three groups.Multivariate Cox regression analysis also demonstrated that a preoperative duration of symptoms 24 months or less and postoperative histology being thymic hyperplasia favourably influenced the outcome.Conclusion The role of thymectomy in patients with ocular myasthenia gravis can relieve symptoms effectively and avert or decrease the potential development of generalized symptoms.Thymectomy,which has a low postoperative mortality and morbidity,may be a first-line option of the therapeutic armamentarium to treat ocular myasthenia gravis.Thymectomy via VATS has clinical advantages of minimal trauma,less pain,fast recovery,and the comparable clinical results over via the traditional sternotomy.Therefore,this procedure deserves to be advocated for ocular myasthenia gravis.

Intravenous Neostigmine Test for Diagnosis of Ocular Myasthenia Gravis

PURPOSE: In the present study, we evaluated the validity of intravenous neostigmine administration combined with alternate prism cover test (APCT) measurement as a confirmatory diagnostic method for confusing cases of myasthenia gravis with ocular involvement. METHODS: Neostigmine was administered intravenously in 26 suspicious myasthenic diplopia patients under electrocardiographic monitoring. Distance deviation at primary position was evaluated with APCT at 5, 10, 15, 20, and 30 minutes after intravenous injection of neostigmine. Margin reflex distance was also evaluated at each time point. RESULTS: Seven of 26 patients were diagnosed as myasthenic diplopia based on a positive neostigmine test. Among these patients, 6 had strabismus at the primary position and 5 patients had ptosis. In patients who showed positive results, all 6 patients showed improvement of strabismus. However, ptosis was not improved in 1 patient. The improvement of strabismus and ptosis reached a peak at 10 to 15 minutes after neostigmine administration. CONCLUSIONS: Intravenous neostigmine administration combined with APCT is a rapid, objective and safe method in hard-to-diagnose cases of myasthenia gravis with ocular involvement. When performing the neostigmine test for myasthenia gravis with ocular involvement, not only the lid position but also strabismus should be evaluated quantitatively to avoid a false negative results.

Analysis for the effect of different regimens on ocular myasthenia gravis in children / 中南大学学报(医学版)

Objective:To evaluate the efficacy,recurrent risk factors and transferable ratio of treatments with 3 different regiments on children with systematic myasthenia gravis (MG).Methods:The data of 104 children with ocular MG from June 2010 to March 2014 were collected from Department of Pediatric Neurology of Xiangya Hospital and they were retrospectively studied.The patients were divided into 3 groups:a methylprednisolone group (n=44),a prednisone group (n=48) and a bromine pyridostigmine group (n=12).Evaluative system from American MG foundation was used to evaluate the efficacy of treatment and the ratio of ocular MG transformed into systematic MG.Results:The efficacy in the methylprednisolone group was better than that in the prednisone group,and both of them were better than that in the bromine pyridostigmine group (both P＜0.05).Methylprednisolone,prednisone combined with bromine pyridostigmine could reach a better long-term efficacy in children with ocular MG.Early treatment with glucocorticoid could reduce clinical relapse.Conclusion:A treatment with high-dose methylprednisolone pulse can improve early clinical remission in children with ocular MG.However,there is a similar efficacy in the long run of different glucocorticoid therapeutic regiments.A relatively order onset age,infection and thyroid dysfunction are recurrent risk factors in children with ocular MG.

Ocular Myasthenia Gravis: A Review.

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction of skeletal muscles. Patients affected with MG may present with ocular features or develop ocular involvement later in the course of the disease, known as ocular MG (OMG). OMG can mimic ptosis, commitant and incommitant strabismus, cranial nerve palsies, gaze palsies and internuclear ophthalmoplegia. Hence, it is important to establish a correct diagnosis and start appropriate treatment. This review focuses on the clinical features, diagnosis, and management of OMG.

Ocular myasthenia gravis: A review.

Myasthenia gravis (MG) is a disease that affects the neuro‑muscular junction resulting in classical symptoms of variable muscle weakness and fatigability. It is called the great masquerader owing to its varied clinical presentations. Very often, a patient of MG may present to the ophthalmologist given that a large proportion of patients with systemic myasthenia have ocular involvement either at presentation or during the later course of the disease. The treatment of ocular MG involves both the neurologist and ophthalmologist. Thus, the aim of this review was to highlight the current diagnosis, investigations, and treatment of ocular MG.

The Clinical Features of Ocular Myasthenia Gravis in Thyroid-Associated Ophthalmopathy

PURPOSE: There are some challenges to accurate diagnosis of ocular myasthenia gravis (MG) in thyroid-associated ophthalmopathy (TAO) patients because the clinical features of these diseases are similar. The aim of this study was to discuss the clinical features and treatment options that may help differentiate these 2 diseases. METHODS: We performed a retrospective analysis using the medical records of patients who visited our clinic and were diagnosed with ocular MG and TAO, from January 2002 to December 2012. The diagnosis of Ocular MG was made on the basis of clinical symptoms and signs with laboratory evaluation, including assays for antithyroid and antiacetylcholine receptor (AchRAb) antibodies, and the Ice, neostigmine, and electromyography tests. RESULTS: Of the 9 ocular MG patients with associated ophthalmopathy, 5 were male and 4 were female. The mean age was 36 +/- 16.0 years and the follow-up period was 45.6 +/- 36.6 months. Graves' disease (8 patients) was predominant and all patients showed abnormal thyroid function. Atypical symptoms and/or mild clinical features were predominant in ocular MG patients with TAO. Positive test results were obtained as follows: Neostigmine test 33.3%, electromyography 44.4%, ice test 77.8% and anti-AchR titer test 77.8%. Thyroid function test results were abnormal in all patients. In 3 patients who were first diagnosed with TAO, symptoms remained persistent despite steroid therapy then improved dramatically by administration of an anti-acetylcholinesterase agent. These patients were diagnosed with ocular MG in conjunction with TAO. CONCLUSIONS: Patients with thyroid disease who show atypical features, symptomatic changes with fatigue, odd appearing ptosis, and who, do not exhibit good response to treatment of TAO need to be examined for ocular MG with additional tests and treatment.

Update in ocular myasthenia gravis / 国际儿科学杂志

Myasthenia gravis is an autoimmune disease caused by the failure of neuromuscular transmission,which is mediated by autoantibodies against acetylcholine receptors.Ocular myasthenia is a form of myasthenia gravis in which weakened eye muscles cause double vision or drooping eyelids.It accounts for approximately 80％ of juvenile myasthenia gravis.This review focuses on the extraocular muscle susceptibility to myasthenia gravis and the management of ocular myasthenia gravis.

Miastenia grave y miastenia grave ocular / Myasthenia gravis and ocular myasthenia gravis

La miastenia grave es una enfermedad caracterizada por debilidad y fatiga de los músculos voluntarios debido a una trasmisión anómala a nivel de la unión neuromuscular. La prevalencia es aproximadamente de 5 casos/100 000 personas. La miastenia grave puede ser bulbar, ocular o generalizada. Existen formas clínicas en la infancia como son la miastenia neonatal transitoria, la miastenia congénita y la miastenia juvenil. Los músculos oculares, faciales y bulbares son los más frecuentes afectados por la enfermedad. Cuando los síntomas se limitan a la musculatura cercana al ojo se denomina miastenia grave ocular. Una vez el oftalmólogo diagnostica o sospecha la miastenia grave, un neurólogo generalmente dirige la comprobación y tratamiento. El papel del oftalmólogo continúa siendo importante, además de chequear la motilidad y disfunción palpebral y proporcionar el alivio sintomático para estos desórdenes, debe estar alerta a la posibilidad de ambliopía

Myasthenia gravis is an illness characterized by weakness and fatigue of the voluntary muscles due to an anomalous transmission at neuromuscular juncture. The prevalence rate is approximately 5 cases/100 000 people. Myasthenia gravis can be bulbar, ocular or widespread. Clinical forms exist in the childhood such as neonatal transitory myasthenia, congenital myasthenia and juvenile myasthenia. The ocular facial and bulbar muscles are the most frequently affected by this illness. When the symptoms occur in the musculature close to the eye, it is named ocular myasthenia gravis. Once the ophthalmologist suspects of or diagnoses myasthenia gravis, a neurologist generally leads the confirmation tests and the treatment. The role of the ophthalmologist continues being important, since he should check the palpebral motility and dysfunction, provide the relief to symptoms and be alert to the probable amplyopia

Ocular Myasthenia Gravis in Conjunction with Thyroid-Associated Ophthalmopathy: A Case Report

PURPOSE: To report a case of ocular myasthenia gravis in conjunction with thyroid-associated ophthalmopathy in a patient who showed incomitant strabismus and blepharoptosis as well as to discuss the clinical features and tests that may help distinguish these 2 diseases. CASE SUMMARY: A 46-year-old man without any previous history of systemic and ophthalmic disease presented with binocular diplopia that occured a month earlier. The patient had no other systemic symptoms except a 7 kg weight loss within the last month. The patient was referred to the department of internal medicine and brain magnetic resonance imaging was performed to ascertain the cause of suspected left superior oblique muscle palsy. The patient was diagnosed with Graves' disease and underwent medical treatment. One month later, the patient presented with consistent diplopia and exophthalmos and showed a swelling of eyelid and ptosis in the right eye. Intravenous high-dose steroid therapy was administered to the patient. After the treatment, symptoms of diplopia and lid swelling were improved, however ptosis persisted. Ocular myasthenia gravis was suspected and various tests were conducted. Anti-acetylcholine receptor antibodies were detected in large amounts and ptosis was improved dramatically by an administration of an anticholinesterase agent. The patient was diagnosed with ocular myasthenia gravis in conjunction with thyroid-associated ophthalmopathy. CONCLUSIONS: Ocular myasthenia gravis should be suspected in patients with thyroid-associated ophthalmopathy who have signs or symptoms of ptosis.

A case of Graves' disease associated with ocular myasthenia gravis / 대한내과학회지

Myasthenia gravis and autoimmune thyroid disorders often overlap. It is known that hyperthyroidism occurs in 2~17.5% of patients with myasthenia gravis. Thyrotoxicosis may influence the clinical course of myasthenia gravis. Overlapping clinical features may cause diagnostic confusion when Graves' disease and myasthenia gravis co-exist. Thus, various tests may be needed to distinguish these two diseases. It is clinically important to screen patients with myasthenia gravis for the co-existence of autoimmune thyroid disorders and vice versa. We cared for a patient with Graves' disease associated with ocular myasthenia gravis who presented with fluctuating double vision and ptosis. Ocular myasthenia gravis was diagnosed by electrophysiologic study and presence of acetylcholine receptor antibody. The patient had a favorable clinical and laboratory response to treatment with an anticholinesterase (pyridostigmine) and an antithyroid drug (propylthiouracil), and he had minimal symptoms at the 9-month follow-up examination.

Ocular Findings in Children with Ocular Myasthenia Gravis

PURPOSE: In order to make an accurate diagnosis, we investigated clinical manifestations and ocular findings in children with ocular myasthenia gravis that can be easily misdiagnosed. METHODS: The medical records of 7 boys and 18 girls under the age of 15 years with ocular myasthenia gravis were reviewed retrospectively. The mean follow-up period was 37 months. RESULTS: The mean age at onset was 37 months. Ptosis was found in 22 patients(88%), strabismus in 21 patients(84%) and amblyopia in 5 patients(20%). Exotropia combined with vertical heterotropia was the most frequent type of strabismus. Ocular motility abnormality was found in 17 patients(68%). The limitation of supraduction or infraduction was most frequently observed. The manifestations of strabismus and ocular motility abnormality were variable and frequently changed during follow-up period. Prednisolone was used more often than pyridostigmine as a maintenance therapy. Ptosis was more responsive to drug therapy than strabismus. CONCLUSIONS: The main ocular findings in ocular myasthenic children were ptosis and exotropia that was not commonly found in Caucasian children. Vertical heterotropia as well as ptosis were commonly accompanied with the horizontal heterotropia. The type and angle of strabismus as well as ocular motility in duction/version were variable during follow-up period

Comparative study of edrophonium test and neostgmine test in ocular myasthenia gravis.

To compare the sensitivity of edrophonium test and neostigmine test in ocular myasthenia. Materials and methods: the edrophonium and neostimine tests in 57 consecutive patients who presented with symptoms of ptosis and/or binocular diplopia upon exertion were studied prospectively in Neuroophthalmologic Unit, Siriraj Hospital. The palpebral fissure, marginal reflex distance (MRD), levator palpebare superioris muscle function and angle of deviation by Prism and cover test were measured before and after performing the tests for evaluation of positive result of the edrophonium and neostigmine tests. All patients were treated with pyridostigmine for one week. The patients who responded to the treatment were diagnosed as ocular myasthenia gravis. Statistical analysis was carried out by the Chi-square test. Results: Forty-five patients were diagnosed as ocular myasthenia gravis and 12 patients were nonmyasthenic group. The edrophonium test was positive in 44 patients (97.8%) and the neostigmine test was positive in 38 patients (84.4%) in myasthenic group. In nonmyasthenic group, 12 patients (100%) were found negative in both tests. Edrophonium produced more severe side effects than neostigmine. Conclusion: The neostigmine test displayed similar positive result compared with the edrophonium test but is safer and easier to perform.