Beneficial effects of corticosteroids on ocular myasthenia gravis.
OBJECTIVE
To determine if moderate-or low-dose corticosteroid therapy can reduce the diplopia and frequency of deterioration to generalized disease in ocular myasthenia gravis.


METHODS
Retrospective record review.


METHODS
Two university-based neuro-ophthalmology services.


METHODS
All 32 patients with ocular myasthenia gravis, treated with prednisone, followed up for a minimum of 2 years were included. Patients were treated with 1 or more courses of daily prednisone (highest initial dose, 40-80 mg) gradually withdrawn over 4 to 6 weeks. Subsequently, in 6 patients, 2.5 to 20 mg of prednisone was given on alternate day.


METHODS
Diplopia in the primary position or downgaze diplopia and generalized myasthenia gravis after 2 years of follow-up.


RESULTS
Diplopia, which was initially found in the primary position in 29 patients and in the downgaze position in 26 patients, was absent in 21 patients at 2 years. Generalized myasthenia gravis occurred in 3 patients at 2 years. Elevated serum acetylcholine receptor antibody levels and abnormal electromyography findings were not predictive of worsening. No patient experienced a major steroid complication.


CONCLUSIONS
Moderate-dose daily prednisone for 4 to 6 weeks, followed by low-dose alternate-day therapy as needed, can control the diplopia in patients with ocular myasthenia gravis. The frequency of deterioration to generalized myasthenia gravis at 2 years may be reduced; 9.4% in this study compared with more than 40% previously reported frequency. Corticosteroids may be useful even when ocular motor dysfunction is not normalized.
Kupersmith
M J
MJ
Department of Ophthalmology and Neurology, New York University Medical Center, New York, USA.
Moster
M
M
Bhuiyan
S
S
Warren
F
F
Weinberg
H
H
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D009157:Myasthenia Gravis / Q000188:drug therapy*
D000305:Adrenal Cortex Hormones