Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong, Kangnam-gu, Seoul, Republic of Korea.
Graefes Arch Clin Exp Ophthalmol. 2013 Mar;251(3):895-901. doi: 10.1007/s00417-012-2227-x. Epub 2012 Dec 30.
The purpose of this study was to describe the treatment experiences and outcomes of patients with myasthenia gravis (MG) whose initial presenting symptom was diplopia
A retrospective review was performed on a group of patients with MG whose initial presenting symptom was diplopia.
The mean age of onset was 45.5 ± 16.9 years, and the mean follow-up period was 45.4 ± 39.7 months. Exotropia with vertical heterotropia was the most common type of deviation. The mean horizontal deviation was 20.1 ± 17.9 prism diopters, and the mean vertical deviation was 14.8 ± 11.1 prism diopters. Limitation of eye movement was found in 20 patients (71.4 %) during the follow-up period. After conventional treatment for MG, six patients (21.4 %) showed a good response with resolution of diplopia. Four patients (14.3 %) showed a partial response to treatment. Eighteen patients (64.3 %) showed minimal or no response; among them, ten (35.7 %) had an angle of deviation of 15 prism diopters or more. Six patients underwent strabismus surgery. Four were symptom free, and satisfactorily aligned after surgical treatment. One patient had intermittent diplopia despite the small amount of deviation, and one patient experienced recurrence of exotropia with diplopia during the 10-year follow-up. In multivariable analysis, the only factor associated with the need for strabismus surgery was the initial angle of deviation (p = 0.016).
Patients with MG who have a larger angle of deviation at presentation tend to require strabismus surgery after stabilization of the disease. Strabismus surgery is one treatment option for patients with MG who have a large angle of deviation and respond poorly to conventional treatment.
本研究旨在描述以复视为初始表现的重症肌无力（MG）患者的治疗经验和结局。
对一组以复视为初始表现的 MG 患者进行回顾性分析。
发病年龄的平均值为 45.5 ± 16.9 岁，平均随访时间为 45.4 ± 39.7 个月。外斜视伴垂直斜视是最常见的偏斜类型。平均水平斜视为 20.1 ± 17.9 棱镜度，平均垂直斜视为 14.8 ± 11.1 棱镜度。在随访期间，20 例（71.4%）患者出现眼球运动受限。MG 常规治疗后，6 例（21.4%）患者复视缓解，疗效良好。4 例（14.3%）患者治疗部分缓解。18 例（64.3%）患者疗效最小或无效；其中 10 例（35.7%）斜视角度为 15 棱镜度或以上。6 例患者接受斜视手术。4 例术后无斜视且双眼视轴正位，症状消失。1 例尽管斜视角度较小，但仍间歇性复视，1 例在 10 年随访期间复发外斜视伴复视。多变量分析显示，仅初始斜视角度与斜视手术相关（p=0.016）。
MG 患者在疾病稳定后，若初始斜视角度较大，往往需要斜视手术。对于斜视角度较大且对常规治疗反应不佳的 MG 患者，斜视手术是一种治疗选择。
