Session: Poster session B
Paraocular steroids as farmacology managment on a patient with ocular myasthenia gravis. a case report.
Introduction: Myasthenia gravis is a post-synaptic autoimmune disease of the neuromuscular junction with a classic bimodal presentation related to sex, most often affecting young women under 40.
The objective of this case report is to describe the clinical presentation, and therapeutic approach in this particular case and the outcomes, as well as the prognosis.
Isolated ocular myasthenia is rare. While ptosis and diplopia are common presenting symptoms including in patients who will eventually evolve into generalized myasthenia, only 20% of patients will turn out to have pure ocular MG. The diagnostic difficulty with this entity is that only 50% have detectable antibodies to the AChR. Single fiber EMG studies support the diagnosis of neuromuscular transmission failure in patients without detectable antibodies, including ocular myasthenia.
The latter group of patients may also have some minor abnormalities on single fiber EMG studies with borderline increased jitter values making the diagnosis even more challenging. Other diagnostic cues are therefore crucial, and ultimately a muscle biopsy may be necessary to clinch the diagnosis.
Methods: This is a case report about the outcomes using paraocular steroid as treatment of ocular MG.
Results:
The patient was followed closely, once per week for the first month then once every two weeks for a total of 3 months.
The patient didn’t notice changes the first week after the first steroid dose.
The patient received a second dose, but this dose was applied on the contralateral eye.
After two weeks of the first dose, the patient reported that she wasn’t seeing double any longer, and her eyelids were more open.
Conclusions
It seems that using local deposit steroids could be a way of treatment for ocular myasthenia gravis.
Using a local treatment is an advantage because we reduce the risk of getting some systemic secondary effect.