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Long-Term Follow-Up of Strabismus Surgery for Patients With Ocular Myasthenia Gravis

Peragallo, Jason H. MD; Velez, Federico G. MD; Demer, Joseph L. MD, PhD; Pineles, Stacy L. MD

Journal of Neuro-Ophthalmology: March 2013 - Volume 33 - Issue 1 - p 40–44
doi: 10.1097/WNO.0b013e318280d630
Original Contribution

Background: Patients with ocular myasthenia gravis (OMG) may develop strabismus and diplopia. We completed a retrospective observational case series to evaluate long-term surgical outcomes in patients with OMG.

Methods: The medical records of all patients with OMG who underwent strabismus surgery with at least 6 months of postoperative follow-up were reviewed. Nine patients met the study inclusion criteria. The main outcomes, including ocular alignment, number of surgeries, and sensory status were evaluated.

Results: Of these patients, initially 2 had horizontal strabismus alone, 3 had vertical strabismus alone, 3 had both vertical and horizontal strabismus, and 1 patient had vertical and torsional strabismus. The length of preoperative stability was 2.0 ± 2.5 years (range: 0.1–8.0 years). The mean preoperative horizontal and vertical deviations were 40.5 ± 32.5 prism diopters (PD; range: 0–90 PD) and 25.6 ± 36.7 PD (range: 0–120 PD), respectively. The average length of the follow-up after the first surgery was 5.7 ± 4.2 years (range: 0.7–10.6 years). Four patients (44%) underwent 2 operations. For patients requiring a second operation, the time to second operation was 2.3 years (range: 0.4–5.0 years). Six patients (67%) were within 10 PD of orthotropia at distance in primary position at the final visit. Five patients (55%) had single vision after their surgeries.

Conclusion: Strabismus surgery can achieve good long-term binocular alignment in patients with OMG.

Department of Ophthalmology (JHP, FGV, JLD, SLP), Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, California; and Department of Ophthalmology (FGV), Olive View, UCLA Medical Center, Sylmar, California.

Address correspondence to Stacy L. Pineles, MD, Department of Ophthalmology, Jules Stein Eye Institute, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095; E-mail:

Supported by NIH/NEI K23EY021762 (S.L.P.), EY08313 (J.L.D.), Knights Templar Eye Foundation (S.L.P.), Oppenheimer Family Foundation (S.L.P.), Leonard Apt Fellowship (J.H.P.), and Adelaide Stein Fellowship (J.H.P.).

The authors report no conflicts of interest.

© 2013 by North American Neuro-Ophthalmology Society