title: Extended transsternal thymectomy for the treatment of ocular myasthenia gravis.
abstract: BACKGROUND
  The optimal treatment for ocular myasthenia gravis (OMG) remains controversial. We conducted a review of the long-term clinical outcomes of Chinese patients with OMG after extended transsternal thymectomy (ETT) to determine the efficacy of this procedure as a treatment for OMG.
  
  
  METHODS
  We reviewed the cases of 115 consecutive patients with OMG who underwent ETT at our Myasthenia Gravis Research Center between January 2006 and December 2008. Extended transsternal thymectomy was done in patients who had thymoma, resistance to pyridostigmine therapy, or relapse after immunosuppressive therapy. The patients' postoperative responses were defined as strict complete remission (SCR), consisting of an asymptomatic status without medication for more than 12 months; general complete remission (GCR), consisting of an asymptomatic status with low-dose single-drug therapy or without medication for more than 12 months; or improvement, consisting of fewer symptoms or less of a need for medication than before surgery.
  
  
  RESULTS
  The overall complication rate was 7.8%. None of the patients experienced a myasthenic crisis, progression to generalized myasthenia gravis, or mortality. Hyperplasia of the thymus was present in 106 of the 115 patients (92.2%). Among 110 patients on whom follow-up was done postoperatively, 29 (26.4%) were in SCR, 64 (58.2%) showed improvement, 7 (6.4%) remained unchanged, and 10 (9.1%) had a worsening of their conditions. Kaplan-Meier analysis revealed rates of GCR of 41.8% at 24 months and 47.3% at 48 months after surgery, and rates of SCR of 24.5% at 24 months and 26.4% at 48 months. Both univariate analysis and multivariate Cox regression analysis revealed that only preoperative duration of illness was positively associated with GCR (p < 0.001).
  
  
  CONCLUSIONS
  The results of the review indicate that ETT is a safe and effective treatment for OMG, especially in patients with illness of shorter duration.
authors: Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Peoples' Republic of China.
authors: Zhenguo
authors: Z
authors: Liu
authors: Huiyu
authors: H
authors: Feng
authors: Sai-Ching J
authors: SC
authors: Yeung
authors: Ziyu
authors: Z
authors: Zheng
authors: Weibin
authors: W
authors: Liu
authors: Jun
authors: J
authors: Ma
authors: Fo-Tian
authors: FT
authors: Zhong
authors: Honghe
authors: H
authors: Luo
authors: Chao
authors: C
authors: Cheng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D016016:Proportional Hazards Models; D013249:Sternum / Q000601:surgery*; D013934:Thymectomy / Q000379:methods*