Should Ocular Myasthenia Gravis Be Treated with Immunomodulation?

Whether early treatment with immunomodulating therapy is needed for ocular myasthenia gravis (OMG) remains an undecided issue. This comprehensive review of the literature strongly indicates that the two fundamental questions regarding OMG treatment — whether it improves ocular symptoms and whether it reduces the risk for generalization — have not been adequately answered by the studies published to date.

In general, the quality of the published data is low due to an absence of controls, randomization, masking, adequate sample size, or adequate follow-up. Although the data suggest that either azathioprine or corticosteroid therapy reduces diplopia and appears to delay, if not prevent, deterioration to generalized myasthenia gravis (GMG), none…