Thymectomy in Ocular Myasthenia Gravis: Results Before and After Generalization and Prognostic Predictors of Outcomes
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: The role of thymectomy in ocular myasthenia gravis (OMG) remains controversial, particularly before secondary generalization. Methods: We conducted a multicenter retrospective study on 174 OMG patients who underwent thymectomy (112 OMG, 62 generalized OMG [g-OMG]). The primary endpoint was complete stable remission (CSR; MGFA-PIS criteria). Multivariable analyses identified predictors of CSR and generalization. Results: Mean age at surgery was 42.3 ± 13.0 years; 53.4% were male. Thymoma was present in 29.3%. CSR was achieved in 18.9% overall, significantly higher in OMG (23.2%) compared to g-OMG (11.3%, p = 0.036), with 5-year CSR probabilities of 43% vs. 22% (p = 0.017). In non-thymomatous patients, 5-year CSR remained higher in OMG (41% vs. 17%, p = 0.010). Postoperative myasthenic crisis occurred exclusively in g-OMG (8.1%, p = 0.004). Multivariable analysis identified preoperative cholinesterase inhibitor monotherapy as an independent predictor of CSR (HR = 31.776, 95% CI: 4.188–241.111, p = 0.001; non-thymomatous: HR = 19.746, 95% CI: 2.518–154.849, p = 0.005). Minimally invasive techniques (78.6%) were associated with low morbidity (5.2%). Conclusions: Thymectomy during the purely ocular stage is associated with higher CSR rates and lower perioperative neurological risk than after generalization, particularly in non-thymomatous disease. Use of cholinesterase inhibitors as sole therapy prior to thymectomy independently predicts CSR. These findings support earlier surgical consideration in selected OMG patients and highlight the safety of minimally invasive approaches.
Source: Journal of Clinical Medicine
DOI: 10.3390/jcm14217840
Authors: Dania Nachira, Maria Teresa Congedo, Khrystyna Kuzmych, Amelia Evoli, Raffaele Iorio, Maria Letizia Vita, Leonardo Petracca-Ciavarella, Adriana Nocera, Carolina Sassorossi, Jessica Evangelista, Paraskevas Lyberis, Giovanni Maria Comacchio, Jury Brandolini, Vittorio Aprile, Carmelina Cristina Zifara, Maria Giovanna Mastromarino, Alexandro Patirelis, Elena Asteggiano, Marco Anile, Federico Venuta, Andrea Imperatori, Vincenzo Ambrogi, Piergiorgio Solli, Andrea Dell’Amore, Marco Lucchi, Franca Melfi, Mohsen Ibrahim, Enrico Ruffini, Federico Rea, Stefano Margaritora, Elisa Meacci
Institutions: Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, University of Turin, University of Padua, University of Pisa, Azienda Ospedaliera Universitaria Pisana, Policlinico Tor Vergata, University of Insubria, Policlinico Umberto I, Sapienza University of Rome, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Calabria, Azienda Ospedaliera Sant'Andrea
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,137
OpenAlex ID: W4415930763