Beneficial effects of corticosteroids on ocular myasthenia gravis
M. J. Kupersmith, M. Moster, S. Bhuiyan, F. Warren and H. Weinberg
Department of Ophthalmology and Neurology, New York University Medical Center, New York, USA.
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. DESIGN: Retrospective record review. SETTING:
Two university-based neuro-ophthalmology services. PATIENTS: 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withdrawn over 4 to 6 weeks.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. OUTCOME MEASURES: 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.
