Prognosis of Ocular Myasthenia Gravis: Retrospective Multicenter Analysis.

PURPOSE

To calculate the rate and timing of conversion from ocular myasthenia gravis to generalized myasthenia gravis.

DESIGN

Retrospective multicenter analysis.

SUBJECTS

Patients included in the study were diagnosed with ocular myasthenia gravis without the presence of generalized disease at onset.

METHODS

We conducted a retrospective multicenter analysis. We reviewed charts of 158 patients who met diagnostic criteria for ocular myasthenia gravis. Patients were divided into 2 subgroups: an immunosuppressant treatment group and a nonimmunosuppressant treatment group. Timing of conversion to generalized disease and duration of follow-up also was evaluated. Additional data such as clinical symptoms at presentation, laboratory test results, and chest imaging results also were recorded.

MAIN OUTCOME MEASURES

Conversion rates to generalized myasthenia at 2 years, effect of immunosuppression on conversion, and timing of conversion.

RESULTS

The 158-patient cohort included 76 patients who received immunosuppressant therapy; the remaining 82 patients did not. The overall conversion rate to generalized disease was 20.9%. At 2 years, generalized myasthenia developed in 8 of 76 patients in the treated group and in 15 of 82 patients in the nonimmunotherapy group (odds ratio, 0.52; 95% confidence interval, 0.20-1.32). Median time for conversion to generalized disease was 20 months in the nonimmunosuppressant group and 24 months in the immunosuppressant group. Conversion occurred after 2 years of symptom onset in 30% of patients.

CONCLUSIONS

Conversion rates from ocular to generalized myasthenia gravis may be lower than previously reported both in immunosuppressed and nonimmunosuppressed patients. A subset of patients may continue to convert to generalized disease beyond 2 years from onset of symptoms, and close monitoring should be continued.