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J. Boumendil, C. Vignal-Clermont, J. Allali, J.-L. Dufier, S. Morax; Clinical Polymorphism of Myasthenia Gravis Beginning With Isolated Ocular Symptoms. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4035.
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the aim of this study is to highlight the clinical diversity of myasthenia gravis beginning with isolated ocular symptoms.
we present a 15 patients series that we have been taking care of at Rothschild’s Ophthalmologic Foundation from 2002 to 2007. Every patients have been examinated by the same ophthalmologist for isolated ocular symptoms. An acetylcholin-receptor antibodies research, a cerebral RMI and a chest tomography have been systematically realized.
When the disease was diagnosed, 11 patients out of 15 had a ptosis with a diplopia, 2 had an isolated ptosis and 2 had an isolated diplopia. After investigations, we discovered that three patients had a malignant thymoma and one had a thymic hyperplasia. An autoimmune disease association has been found with 2 patients: the first one had a Hashimoto’s thyroiditis and the second one has developed an optical neuro-myelitis few years after his myasthenia gravis. Only three patients secondarily developed a generalized myasthenia gravis. This could be explained by the early attending of these patients, and the common prescription of an immunosuppressive therapy reducing the risk of secondarily generalised myasthenia gravis according to some studies.
Despite the small number of patients, this study well underlines the clinical polymorphism of ocular myasthenia gravis, the risks it may cause, and the important role of the ophthalmologists in the diagnosis of this disease. Close collaboration between ophthalmologists and neurologists is needed to ensure a well taking care of these patients.
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