안중증근무력증의 안과적 임상 양상
Ophthalmologic Manifestations of Ocular Myasthenia Gravis
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목적: 안중증근무력증 환자의 안과적 임상 양상을 알아보고자 하였다. 대상과 방법: 2011년 1월부터 2022년 8월까지 본원 안과 및 신경과에 내원하여 안중증근무력증으로 진단받은 환자 중 6개월 이상추적 관찰이 가능하였던 58명을 대상으로 안과적 임상 양상 및 경과를 후향적으로 분석하였다. 결과: 총 58명의 환자에서 발병 시 평균 연령은 55.52 ± 15.60세로 남성 29명, 여성 29명이었다. 항아세틸콜린수용체항체검사에서양성 31명으로 양성률은 53.45%였고, 반복신경자극검사는 양성 19명, 음성 38명으로 33.33%에서 이상을 보였다. 항체 양성군에서전신근무력증으로 더 많이 진행하였으며(p=0.011), 더 많은 흉부 이상 소견을 보였다(p<0.001). 복시와 안검하수가 동반된 복합군에서수평, 수직복시가 모두 있는 경우가 많았으며(p<0.001), 사시의 양상이 복시 증상 단일군에서는 내사시, 복합군에서는 외사시가 가장많아 차이가 있었다(p=0.029). 또한 증상 복합군에서 항체 농도가 높게 측정되었으며(p=0.034), 반복신경자극검사에서 이상 소견을보이는 경우가 많았고(p=0.022) 더 많은 흉부 이상 소견을 보였다(p=0.022). 결론: 안중증근무력증 환자에서 항아세틸콜린수용체항체 양성군에서 전신 중증근무력증으로 진행한 경우가 많았고, 복시와 안검하수가 동반된 복합군에서 항아세틸콜린수용체항체 농도가 높았으며, 수평사시와 수직사시가 함께 동반되는 경우가 많았다.
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.
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