Researchers find that long-acting agents, such as triamcinolone, are effective for treating ocular myasthenia gravis (OMG). Oral myasthenia gravis is a condition characterized by weakness in the muscles controlling eye movements and eyelids. The use of peribulbar injections with dexamethasone and triamcinolone, according to a new study, constitutes a safer and better localized alternative, suggesting their efficacy in maintaining permanent resolution of symptoms. The study was published in the Journal of Neuro-Ophthalmology by Lasry R. and colleagues.
OMG weakens the extraocular muscles around the eyes, which often leads to paralysis of eye movements and ptosis or drooping eyelids. Oral treatments with corticosteroids are well established but carry the risk of side effects to so many other body tissues that localized treatments are highly desirable. This article reports on the use of peribulbar corticosteroid injections in OMG patients, thereby providing a more localized form of treatment.
A retrospective chart review was performed in order to determine the effectiveness of peribulbar corticosteroid injections in a small group of patients who had ocular myasthenia gravis. Five patients who received that treatment could be identified for the case-analysis. The study focused on the effects of peribulbar dexamethasone or triamcinolone (40-mg Triesence), which is a longer-acting corticosteroid, which targets the area behind the eye rather than injecting the affected extraocular muscles itself. The results of resolution of symptoms, time to treatment, and recurrence of symptoms after injection were monitored by the review.
Of the total five patients inducted:
• Four patients had isolated ophthalmoparesis, that manifested as paralysis of eye muscles
• One patient had isolated ptosis.
• Four of the five patients had combinations of ptosis and ophthalmoparesis.
• Cases of ptosis and ophthalmoparesis are documented in three out of four cases, where symptoms subsided completely within a few weeks after one single injection in the peribulbar region.
• Symptoms remained improved for 5 to 6 months, and patients responded well to repeated injections in cases of symptom relapse.
In summary, peribulbar corticosteroids, mainly triamcinolone, hold considerable promise as a treatment for ocular myasthenia gravis with a possibility of holding relief for many months after less injection. This treatment carries minimal systemic adverse effects and, hence, is a more friendly option to the patient. As such, the healthcare providers should henceforth consider the peribulbar triamcinolone approach as an effective alternative for the management of OMG, especially in patients who experience frequent relapse of symptoms.
Reference:
Lasry, R., Gotkine, M., & Kruger, J. M. (2024). Peribulbar corticosteroids for ocular myasthenia gravis. Journal of Neuro-Ophthalmology: The Official Journal of the North American Neuro-Ophthalmology Society, 44(3), 419–422. https://doi.org/10.1097/wno.0000000000002148