OCT 21, 2010
Neuro-Ophthalmology/Orbit, Pediatric Ophth/Strabismus
The authors conducted a retrospective chart review of 39 pediatric patients with ocular myasthenia gravis treated at one children's hospital over a 16-year period. The study, which is the largest single-center cohort of pediatric ocular myasthenia gravis described to date, evaluated visual and systemic outcomes in patients followed for at least one year. The authors conclude that the condition is readily treatable in most patients.
Among the children included in the review, 15 were treated with pyridostigmine only, 19 also received steroids, 15 underwent thymectomy and four received steroid-sparing immunosuppressive therapy. The children, with a mean age of 5.4 years, were followed for a mean of 4.8 years.
Disease resolution occurred in 10 patients (24 percent), while nine (23 percent) developed generalized myasthenia. Ten patients were treated for amblyopia, although only one had amblyopia at the final visit. The authors found no correlation between sex or age and amblyopia or the development of generalized symptoms. Thymectomy, when performed before the onset of generalized symptoms, showed a trend toward protection from the development of generalized symptoms (P = 0.07).
The study's findings suggest that pediatric patients with the condition have a relatively low risk of developing generalized disease and that related amblyopia can be successfully treated when it occurs. However, the authors note that since they were unable to identify patient characteristics associated with amblyopia, clinicians should remain vigilant in all children younger than eight to 10 years with ocular myasthenia gravis.