Strabismus surgery shows good long-term results in myasthenia gravis

This retrospective study found that extraocular muscle surgery is a viable option for patients with ocular myasthenia gravis and stable ocular alignment. However, these patients should be counseled regarding the possibility of multiple surgeries, especially in those with more severe disease, older age and coexistent restrictive strabismus.

The authors reviewed the charts of nine patients who underwent strabismus surgery with the adjustable suture technique and without botulinum toxin injections. Of these patients, two had horizontal strabismus alone, three had vertical strabismus alone, three had both vertical and horizontal strabismus, and one had vertical and torsional strabismus. The minimum follow-up was six months, and the average follow-up after the first surgery was 5.7 years, with 89 percent of patients followed for more than one year.

All patients showed improved ocular alignment from initial deviation. At the final visit, 56 percent of patients were within 10 PD of orthotropia. Four patients underwent two operations, with a mean time between operations of 2.3 years. Five patients had single vision after their surgeries.

The authors note that strabismus surgery was less successful in older patients and those with mysasthenia gravis and thymectomy, positive acetylcholine receptor antibodies, and generalized disease. There was no correlation between length of stability of preoperative ocular alignment and long-term success. Several patients with positive forced ductions had a poor outcome.