Myasthenia gravis with ocular involvement in older patients

Background: There has been little previous study reporting the eye findings and presentation of elderly patients with myasthenia gravis. The purpose of this study was to review the findings and course of myasthenia gravis after the sixth decade of life. Methods: Retrospective observational case series. The authors reviewed the clinical records of 27 patients with onset of myasthenia gravis at age 60 years or more who were seen at a tertiary care academic ophthalmology centre in Houston between January 1992 and March 1999. The diagnosis of myasthenia gravis was based on conventional clinical and laboratory criteria. Results: Twenty patients (74%) were men. Of the 16 patients who underwent testing for anti-acetylcholine receptor antibodies, I I (69%) were seropositive. Concurrent thyroid disease was found in seven patients (26%), including five (71 %) of the seven women. No patient had thymoma. Sixteen patients (59%) manifested generalized symptoms during follow-up; 12 did so within I year of disease onset. Patients responded well to both anticholinesterase and corticosteroid therapy. At the most recent follow-up visit 18 patients (67%) were clinically improved, and no patient was clinically worse. Interpretation: Myasthenia gravis in this study was characterized by a male predominance, high rate of concurrent thyroid disease, high rate of progression to mild generalized symptoms, absence of thymoma, good response to medical therapy and minimal life-threatening complications. Clinicians should consider the diagnosis of myasthenia gravis in an older patient presenting with diplopia or ptosis. Contexte : Peu d'études précédentes ont présenté des données oculaires sur la myasthénie grave chez les patients âgés. Cette étude a pour objet d'examiner les données et l'évolution de cette maladie après six décennies de vie. Methodes : Les auteurs ont examiné de façon rétrospective les dossiers cliniques de 27 patients dont la myasthénie grave a commencé à l'âge de 60 ans ou plus et qui ont été examinés clans un centre de soins tertiaires d'ophtalmologie de Houston entre janvier 1992 et mars 1999. Le diagnostic de la myasthenie grave s'appuyait sur les critères cliniques et de laboratoire conventionnels. Résultats : Vingt patients (74 %) étaient des hommes. Parmi les 16 patients qui avaient subi des tests pour deceler la présence d'anticorps contre les récepteurs d'acétylcholine, 11 (69 %) furent trouvé séropositifs. On a trouvé une maladie concurrente de la thyroïde c