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 Table of Contents  
Year : 2022  |  Volume : 34  |  Issue : 3  |  Page : 291

Comments on: Off-center presentation of ocular myasthenia

Regional Institute of Ophthalmology, Thiruvananthapuram, Kerala, India

Date of Submission28-Nov-2022
Date of Decision28-Nov-2022
Date of Acceptance28-Nov-2022
Date of Web Publication22-Dec-2022

Correspondence Address:
Dr. Anooja R Babu
Regional Institute of Ophthalmology, Thiruvananthapuram, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kjo.kjo_126_22

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How to cite this article:
Babu AR. Comments on: Off-center presentation of ocular myasthenia. Kerala J Ophthalmol 2022;34:291

How to cite this URL:
Babu AR. Comments on: Off-center presentation of ocular myasthenia. Kerala J Ophthalmol [serial online] 2022 [cited 2023 Feb 2];34:291. Available from: http://www.kjophthal.com/text.asp?2022/34/3/291/364714

The case report “Off-center Presentation of Ocular Myasthenia” by Dr. Mary A. Stephen has highlighted the case report of a 70-year-old diabetic male who presented with diplopia.[1] The article brilliantly described a presentation of ocular myasthenia and highlighted the need for a high degree of suspicion for timely diagnosis of ocular Myasthenia Gravis. In this case, the initial diagnosis of diabetic mononeuropathy changed to ocular myasthenia when the initial presentation of unilateral ptosis gradually evolved to bilateral ptosis. Early detection of myasthenia is important as the management of diabetic mononeuropathy is entirely different from that of myasthenia, which the author achieved by meticulous examination of the patient and by timely clinical suspicion.

From an academic point of view, the few points that I would like to contribute include:

  1. Thoracic imaging like MRI or CT scan could have been done to detect thymoma, as it is present in 15% of cases.[2],[3]
  2. Testing for striational antibodies can help determine the severity as it is a marker of severe Myasthenia Gravis (MG). Nearly all patients with MG and thymoma and half of the late-onset MG subgroup demonstrate the presence of striational antibody.[4]
  3. In seropositive cases, the titers of AchR (Acetylcholine Receptor) antibody are found to be significantly higher in patients who progressed to generalized disease than those whom it remained as ocular.[5]

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Conflicts of interest

There are no conflicts of interest.

  References Top

Stephen MA, Jayasri P, Harigaravelu P J. Off-center presentation of ocular myasthenia. Kerala J Ophthalmol 2022;34:164-6.  Back to cited text no. 1
  [Full text]  
O'Hare M, Doughty C. Update on ocular myasthenia gravis. Semin Neurol 2019;39:749-60.  Back to cited text no. 2
Fortin E, Cestari DM, Weinberg DH. Ocular myasthenia gravis: An update on diagnosis and treatment. Curr Opin Ophthalmol 2018;29:477-84.  Back to cited text no. 3
Nair AG, Patil-Chhablani P, Venkatramani DV, Gandhi RA. Ocular myasthenia gravis: A review. Indian J Ophthalmol 2014;62:985-91.  Back to cited text no. 4
[PUBMED]  [Full text]  
Kusner LL, Puwanant A, Kaminski HJ. Ocular myasthenia: Diagnosis, treatment, and pathogenesis. Neurologist 2006;12:231-9.  Back to cited text no. 5


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