American Academy of Ophthalmology
Benatar and Kaminski performed a recent review of the literature searching for evidence-based recommendations for the treatment of ocular myasthenia gravis (OMG). Myasthenia gravis is an immune-mediated neurologic disorder that presents with ocular symptoms approximately 50% of the time (Oosterhuis 1989; Bever et al 1983). In about 50% of patients presenting with ocular symptoms, the disease will continue to affect only the ocular muscles, while in the remainder, it will progress to generalized myasthenia gravis with widespread muscular weakness, which in some cases can be life-threatening. There are no current evidence-based guidelines for the appropriate treatment of OMG. It is also unclear whether early immunosuppression may prevent future generalization in patients presenting with OMG.
The researchers searched the Cochrane Neuromuscular Group Register, Medline, and Embase. Evidence was classified as class 1 (randomized, controlled trials—highest level) through class 4 (uncontrolled studies, case series, and so on—lowest level). They found very few well-designed studies evaluating the treatment of OMG across all medical treatment strategies. None of the studies were classified higher than class 4, and the recommendations were graded as “data inadequate or unproven.”
Although Benatar and Kaminski were unable to provide evidence-based guidelines for treatment of OMG, they do provide an excellent review of the literature. This topic is important for general ophthalmologists because often they are the first physicians to evaluate and diagnose patients with OMG.
REFERENCES
Benatar M, Kaminski HJ. Evidence report: the medical treatment of ocular myasthenia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;68:2144–2149.