Delayed remission after thymectomy for myasthenia gravis of the purely ocular type

Nakamura, Hiroshige; Taniguchi, Yoshihiro; Suzuki, Yoshimasa; Tanaka, Yoshiyuki; Ishiguro, Kiyosuke; Fukuda, Mikihisa; Hara, Hiroshi; Mori, Tohru

doi:10.1016/s0022-5223(96)70264-7

Cited by 55 publications

(21 citation statements)

References 9 publications

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“…However, owing to the positive results in our previous study [24] , fi ndings in the present series, and suggestions of others [6,25,26] , we advocate that early thymectomy in ocular MG could prevent further progression of the disease in becoming generalized.…”

Section: Discussionsupporting

confidence: 45%

Bilateral Video-Assisted Thoracoscopic Thymectomy vs. Extended Transsternal Thymectomy in Myasthenia Gravis: A Prospective Study

Chang

Chou²,

Kao³

et al. 2005

Eur Surg Res

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The optimal approach to thymectomy remains controversial. This study is designed to prospectively compare the results between bilateral video-assisted thoracoscopic thymectomy (BVTx) and extended transsternal thymectomy (ETTx) in patients with myasthenia gravis (MG) without thymoma. Fifteen patients who had undergone BVTx and 16 patients who had undergone ETTx were compared for age, gender, severity of disease, preoperative duration of disease, operative time, intraoperative blood loss, postoperative complications, hospital stay, duration of chest tube drainage, thymic histopathology, pain perception by visual analog scale (VAS), remission and improvement rate, period of follow-up, and activities of daily living (ADL). Fisher’s exact test, t test and paired t test were used for statistical analysis. BVTx had longer operative time and less intraoperative blood loss than that of the ETTx. Their remission rates and their degree of postoperative ADL improvement were not significantly different. However, the lowering of VAS was significantly greater in the sternotomy group at 3 months. All other parameters were not significantly different. No mortality was noted in the series. We consider BVTx as an effective alternative procedure to the transsternal approach for patients with nonthymomatous MG. As more and more people care about cosmetics, BVTx could become the future trend.

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Section: Discussionsupporting

confidence: 45%

Bilateral Video-Assisted Thoracoscopic Thymectomy vs. Extended Transsternal Thymectomy in Myasthenia Gravis: A Prospective Study

Chang

Chou²,

Kao³

et al. 2005

Eur Surg Res

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“…There remains controversial about the indication of thymectomy for OMG (32,33). However, the risk of generalization from OMG to generalized MG (GMG) do exist for part of patients, and certain treatment might delay or prevent the onset of GMG (1).…”

Section: Discussionmentioning

confidence: 99%

Independent long-term result of robotic thymectomy for myasthenia gravis, a single center experience

Yin

Huang²,

Han

et al. 2018

J. Thorac. Dis.

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Background: Robotic thymectomy has been suggested a feasible and safe approach for myasthenia gravis (MG). Few investigations have revealed the independent effect of robotic thymectomy without the confounding impact of immunosuppressive (IM) therapy. Results: Data of 37 cases was available for analysis. The mean follow-up was 70.0±13.3 months. The median age was 40 years. Twelve (32.4%) patients kept free of IM therapy, and 25 (67.6%) patients accepted postoperatively. The overall 5-year complete stable remission (CSR) rate was 40.6% and improvement rate was 81.6%. The young (age ≤40) displayed a significant better CSR rate (P=0.015) and a trend of better improvement rate (P=0.050) compared to the old (age >40). Patients without usage of IM therapy showed significant higher CSR rate (P=0.014) and improvement rate (P=0.024) compared to those with usage of IM therapy. Patients with Myasthenia Gravis Foundation of America (MGFA) classes I showed a trend of higher remission rate by multivariate analysis. No significant differences were found for the remission rate according to gender, pathology, and the duration of symptoms. Conclusions:The mono-therapy of robotic thymectomy may bring with a satisfactory long-term result for part of MG patients. Precision selection and individualized therapy are of the most importance. J Thorac Dis 2018;10(1):321-329 jtd.amegroups.com improvement clinical outcomes by thymectomy for patients with nonthymomatous MG. It was a great stride for surgical treatment of MG, but there still remains several questions with regards to the candidates, the optimal surgical approach, the timing and the extent of resection (4,5).Representing the newest minimal invasive technique, robotic thymectomy has been increasing rapidly worldwide in recent years, as it provides with multiple advantages with less trauma comparing to the open procedure (6-8). The long-term results of robotic thymectomy for MG have also been published by several investigators (9-11). Whereas, immunotherapy as the mainstay of treatment for MG, it is frequently given to thymectomized patients to maintain pharmacologic remission (PR) nowadays (12-15). The usage of immunosuppressants would certainly play a role in the overall remission rate of thymectomized MG patients (16). However, few investigations of robotic thymectomy for MG has separated the confounding influence of immunotherapy when analyze the long-term results. Thus, the actual independent effect of robotic thymectomy for MG patients is unclear.The present report introduces our observation of the relatively independent long-term results after robotic thymectomy for MG. MethodsA retrospectively study was performed for patients who diagnosed as MG and underwent robotic extended thymectomy with da Vinci robotic system (Intuitive Surgical, Inc, Sunnyvale, CA, USA) in department of thoracic surgery of PLA Rocket Force General Hospital between May 2009 and December 2012. The study was approved by the medical ethics committee of PLA Rocket Force General Hospital (approval number ...

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“…One patient required prednisone, developing OMG findings 3 years after thymectomy, and the other had persistent ophthalmoparesis and diplopia despite surgery and later failed prednisone and azathioprine therapy. Small case series reports suggest that thymectomy could have a benefit for improving OMG deficits and reducing deterioration to GMG [26][27][28][29]. However, these studies are far from conclusive due to limited documentation of OMG findings and the frequent inclusion of OMG patients who have had the disease for longer than six months and are therefore at low risk of developing GMG.…”

Section: Discussionmentioning

confidence: 99%

Ocular myasthenia gravis: treatment successes and failures in patients with long-term follow-up

Kupersmith

2009

J Neurol

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We previously reported that prednisone reduced the frequency of generalized myasthenia (GMG) and controlled diplopia without major adverse effects at 2 years in patients with ocular myasthenia gravis (OMG). Questions remain as to whether study subjects had long-standing disease, biasing results towards a steroid benefit, and if prednisone merely delayed GMG onset. Here, we performed a record review of a referral neuro-ophthalmology service OMG database for patients who were followed-up for > or =4 years or until GMG developed. We studied the effect of prednisone on GMG incidence and control of ocular symptoms. Generally, patients with diplopia were recommended for prednisone therapy. Most remained on daily 2.5-10 mg for diplopia control. We compared the results for prednisone-treated and "untreated" (pyridostigmine only) patients. Of 87 patients, 55 were in the prednisone-treated and 32 were in the untreated groups. GMG developed in 7 (13%) of the prednisone-treated (OR 0.41; 95% CI 0.22-0.76) and in 16 (50%) of the untreated (OR 2.78; 95% CI 1.68-4.60) patients. After OMG onset, GMG developed at a mean 5.8 and 0.22 years in prednisone and untreated groups. Diplopia was present at the last exam in 27% of the prednisone-treated (mean 7.2 years) and in 57% of the untreated (mean 4.6 years) OMG patients. For 48 prednisone-treated patients who did not develop GMG, OMG treatment failure occurred in 13. Thus, prednisone delays the onset of GMG and has sustained benefit in reducing the incidence of GMG and controlling diplopia. Without prednisone, GMG develops in 50% of OMG patients, typically within 1 year.

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Delayed remission after thymectomy for myasthenia gravis of the purely ocular type

Cited by 55 publications

References 9 publications

Bilateral Video-Assisted Thoracoscopic Thymectomy vs. Extended Transsternal Thymectomy in Myasthenia Gravis: A Prospective Study

Bilateral Video-Assisted Thoracoscopic Thymectomy vs. Extended Transsternal Thymectomy in Myasthenia Gravis: A Prospective Study

Independent long-term result of robotic thymectomy for myasthenia gravis, a single center experience

Ocular myasthenia gravis: treatment successes and failures in patients with long-term follow-up

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