ABSTRACT
Purpose@#We investigated the ophthalmic manifestations observed in patients diagnosed with ocular myasthenia gravis. @*Methods@#In total, 58 patients diagnosed with ocular myasthenia gravis visited the ophthalmology and neurology departments between January 2011 and August 2022. Patients were followed for > 6 months; their ophthalmic manifestations were analyzed retrospectively. @*Results@#The study included 29 males and 29 females with a mean age of 55.52 ± 15.60 years. Among the patients, 31 tested positive for anti-acetylcholine receptor antibodies, resulting in a positive rate of 53.45%. Abnormalities in repeated nerve stimulation tests were observed in 33.33% of the patients. The antibody-positive group exhibited a higher frequency of progression to generalized myasthenia gravis (p = 0.011) and a higher incidence of chest abnormalities (p < 0.001) compared to the antibody-negative group. Horizontal and vertical diplopia were commonly observed in a complex group of patients with diplopia and blepharoptosis (p < 0.001); there was a difference in the pattern of strabismus between the diplopia single group with esotropia and the complex group with exotropia (p = 0.029). In addition, the combination group demonstrated a higher antibody titer (p = 0.034), a higher frequency of abnormalities in repeated nerve stimulation tests (p = 0.022), and a higher incidence of chest abnormalities (p = 0.022). @*Conclusions@#The anti-acetylcholine receptor antibody-positive group had a higher incidence of progression to generalized myasthenia gravis; moreover, the complex group of patients with diplopia and ptosis exhibited elevated levels of anti-acetylcholine receptor antibodies and frequently accompanied both horizontal and vertical strabismus.
ABSTRACT
Purpose@#We report a case of Tolosa-Hunt syndrome with multiple orbital myositis identified via orbital magnetic resonance imaging in a patient with Crohn's disease who developed right eye pain and binocular horizontal diplopia.Case summary: A 46-year-old woman visited our clinic with a 2-month history of right eye pain and migraine, as well as a 3-day history of acute horizontal diplopia. She had previously been diagnosed with Crohn's disease and was taking immunosuppressive drugs. In the eye movement test, esotropia and an abduction limitation of -3.0 in the right eye were observed on the Krimsky test. There were no specific findings in anterior segment and fundus examinations. Orbital magnetic resonance imaging showed multiple extraocular muscle enhancement in the right eye and multiple extraocular muscle hypertrophy in the left eye. The patient was diagnosed with binocular multiple orbital myositis and right Tolosa-Hunt syndrome; she was treated with high-dose steroids for 3 days followed by lower dose oral medications. During the first week of treatment, the right eye pain disappeared and the right eye abduction limitation showed slight improvement. After 3 months of treatment, the right eye abduction limitation and esotropia completely disappeared. @*Conclusions@#Orbital myositis and Tolosa-Hunt syndrome are idiopathic, nonspecific chronic granulomatous diseases with painful ophthalmoplegia. We describe a rare case in which the two diseases appear together.
ABSTRACT
Purpose@#We report a case of recurrent vitreous hemorrhage in a patient with presumed latent tuberculosis-related intermediate uveitis, and we review the literature.Case summary: A 58-year-old male visited our clinic complaining of ocular pain, conjunctival hyperemia, decreased vision, and uncontrolled intraocular pressure (IOP) in the left eye. The best-corrected visual acuity (BCVA) was 0.4 and the IOP of the left eye was 34 mmHg. Slit lamp examination revealed conjunctival hyperemia, corneal edema, and inflammatory cells in the anterior chamber and anterior vitreous; fundus examination revealed mild vitreous opacity attributable to vitritis. The high IOP and the intraocular inflammation were treated with antiglaucoma agents and corticosteroids under the impression of chronic anterior uveitis and uveitic glaucoma. Of the tests performed to identify the cause of the uveitis-related vitreous hemorrhage, the interferon-gamma release assay was positive. A presumptive diagnosis of latent tuberculosis-related uveitis was made after pulmonary tuberculosis was excluded by our respiratory internal medicine department. Isoniazid was administered for 9 months. The vitreous hemorrhage recurred 1 month after antituberculosis therapy commenced but, at 2 months, all of the hemorrhage was absorbed and the BCVA improved to 1.0 without further recurrence. @*Conclusions@#Intraocular tuberculosis can present with various clinical manifestations. If tuberculosis-related uveitis is presumed, tests for latent and manifest tuberculosis should be scheduled to allow of early diagnosis and immediate antituberculosis therapy.