Predictors of achieving minimal manifestations or better status in ocular myasthenia gravis with immunotherapy.

Abstract

Background: Ocular myasthenia gravis (MG), while less severe than generalized MG, significantly impairs quality of life due to its impact on vision and daily activities. Immunotherapy is a key treatment, yet the optimal timing for initiation remains undefined.

Objective: To identify predictive factors for achieving minimal manifestations (MM) or better status in ocular MG patients receiving immunotherapy, with a focus on the role of early intervention.

Methods: We conducted a retrospective analysis of 48 ocular MG patients treated at our institution. Patients were categorized based on whether they achieved MM or better status. Clinical variables were analyzed using univariate, receiver-operating characteristic, and multivariate logistic regression analyses.

Results: MM or better status was achieved in 34/48 patients (median onset age: 55 years). Time from symptom onset to immunotherapy initiation was significantly shorter in those who achieved MM or better status (median: 30 days vs. 1095 days; p < 0.001). Receiver-operating characteristic analysis determined a 255-day cutoff for immunotherapy initiation, yielding sensitivity of 92.9% and specificity of 91.2% (AUC = 0.986, 95% CI: 0.962-1.000, p < 0.001). Logistic regression confirmed early immunotherapy as an independent predictor.

Conclusions: Early initiation of immunotherapy (< 255 days from onset) significantly improves the likelihood of achieving MM or better status in ocular MG. These findings support the need for prompt diagnosis and treatment to optimize outcomes.