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Controversies in Neurology
December 2007

Treating Ocular Myasthenia Gravis With Inadequate Evidence

Arch Neurol. 2007;64(12):1794-1795. doi:10.1001/archneur.64.12.1794

The essence of wisdom is the ability to make the right decision on the basis of inadequate evidence.—Alan Gregg

We do not know the best way to treat ocular myasthenia gravis (OMG). Every day we must recommend therapy despite the limitations of our knowledge, and the promise of a yet-to-be-completed study is not very helpful for individuals who must decide about treatment now. Gilbert et al1 and Chavis and colleagues2 agree that many patients with OMG go on to develop generalized MG (GMG) and that preventing this progression is desirable. They also agree that immunotherapy with corticosteroids or thymectomy seems to work for OMG. There is concern, however, about the risks of long-term corticosteroid therapy or a major operation, such as thymectomy, and whether these risks can be justified in an individual with only ocular symptoms. The evidence that early immunotherapy in individuals with OMG prevents progression to GMG is weak.