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Mark J. Kupersmith, MD; Mark Moster, MD; Sam Bhuiyan, MD; Floyd Warren, MD; Harold Weinberg, MD

Arch Neurol. 1996;53(8):802-804.

Abstract
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 Patients were treated with 1 or more courses of daily prednisone (highest initial dose, 40-80 mg) gradually withdrawn over 4 to 6 weeks.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.

Author Affiliations
From the Departments of Ophthalmology and Neurology, New York University Medical Center, New York, NY (Drs Kupersmith, Bhuiyan, Warren, and Weinberg), and Albert Einstein Medical Center, Philadelphia, Pa (Dr Moster).

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