Symptoms of the disease remained in the majority of patients with ocular myasthenia gravis treated with immunotherapy, found a new observational study published in the journal Therapeutic Advances in Neurological Disorders. However, the rate of refractory disease was significantly lower following immunotherapy.

“Immunotherapy, including corticosteroids, may be beneficial for patients with [ocular myasthenia gravis],” first author Tomoko Narita, MD, and colleagues concluded.

Read more about guidelines for myasthenia gravis

In order to investigate the treatment of ocular myasthenia gravis and its outcomes, the Japanese team led by Hidenori Matsuo, MD, PhD, from the Department of Neurology at Nagasaki National Hospital and Nagasaki Kawatana Medical Center in Japan performed a retrospective cross-sectional survey of patients from 8 hospitals in the country.

They analyzed a total of 135 patients. They collected clinical information about patients’ sex, age at disease onset, complications, initial symptoms, disease course, treatment history, autoantibodies, and outcomes.

Of these 135 patients, 8 did not need any therapy and went into remission spontaneously. Of the remaining 127, 117 improved following treatment, but 10 were refractory to treatment. 

“Overall outcomes were good,” the researchers reported. But, they added that symptoms remained in 60.7% of the patients following treatment. 

A total of 90 patients received immunotherapy. Of these only, 2 were refractory to treatment. Of the 45 patients who were not treated with immunotherapy, 8 were refractory. 

The authors concluded that the rate of refractory disease in patients treated with immunotherapy was significantly lower than in patients who did not receive immunotherapy.

Ocular myasthenia gravis is a type of myasthenia gravis in which patients only show eye symptoms for more than 2 years. It is not clear whether this type of disease eventually progresses to generalized myasthenia gravis. There is no standard clinical practice for the treatment of ocular myasthenia gravis. 


Narita T, Nakane S, Nagaishi A, et al. Immunotherapy for ocular myasthenia gravis: an observational study in Japan. Ther Adv Neurol Disord. Published online April 4, 2023. doi:10.1177/17562864231163819