Efficacy of Gaze Photographs in Diagnosing Ocular Myasthenia Gravis
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background and Purpose The various tests that are routinely used to diagnose generalized myasthenia gravis, such as the edrophonium test, serum anti-acetylcholine-receptor antibodies (AChR-Ab), and repetitive nerve stimulation (RNS) tests, have lower diagnostic sensitivity in ocular myasthenia gravis (OMG). Diagnosing OMG becomes even more difficult when the clinical symptoms are subtle. There is no gold-standard diagnostic test available for OMG patients, and so this study compared the diagnostic sensitivity of gaze photographs with conventional tests in OMG. Methods Records of gaze photographs were available for 25 of 31 consecutive patients diagnosed with OMG. Each patient underwent a neuro-ophthalmologic examination, serum AChR-Ab, RNS, edrophonium test, ice tests, and the acquisition of gaze photographs. The margin reflex distance 1 (MRD1) was measured on each of the gaze photographs, with MRD1 <2 mm or an interlid MRD1 difference of ≥2 mm on any of the gaze photographs defined as a positive sign of OMG. The diagnostic sensitivities of the tests were assessed. Results The mean age at onset was 38.5 years (range, 2–76 years), and 13 patients (52%) were men. The diagnostic sensitivities of the RNS test, AChR-Ab test, gaze photographs, and ice test were 56%, 64%, 80%, and 73%, respectively. Conclusions The diagnostic sensitivity was higher for gaze photographs than for the other tests applied to OMG patients.
Abstract
Background and Purpose The various tests that are routinely used to diagnose generalized myasthenia gravis, such as the edrophonium test, serum anti-acetylcholine-receptor antibodies (AChR-Ab), and repetitive nerve stimulation (RNS) tests, have lower diagnostic sensitivity in ocular myasthenia gravis (OMG). Diagnosing OMG becomes even more difficult when the clinical symptoms are subtle. There is no gold-standard diagnostic test available for OMG patients, and so this study compared the diagnostic sensitivity of gaze photographs with conventional tests in OMG. Methods Records of gaze photographs were available for 25 of 31 consecutive patients diagnosed with OMG. Each patient underwent a neuro-ophthalmologic examination, serum AChR-Ab, RNS, edrophonium test, ice tests, and the acquisition of gaze photographs. The margin reflex distance 1 (MRD1) was measured on each of the gaze photographs, with MRD1 <2 mm or an interlid MRD1 difference of ≥2 mm on any of the gaze photographs defined as a positive sign of OMG. The diagnostic sensitivities of the tests were assessed. Results The mean age at onset was 38.5 years (range, 2–76 years), and 13 patients (52%) were men. The diagnostic sensitivities of the RNS test, AChR-Ab test, gaze photographs, and ice test were 56%, 64%, 80%, and 73%, respectively. Conclusions The diagnostic sensitivity was higher for gaze photographs than for the other tests applied to OMG patients.
참고문헌 (19)
- Weinberg DA, "Ocular myasthenia: a protean disorder", Surv Ophthalmol, 39, pp.169~210 (1994)[DOI]
- Kusner LL, "Ocular myasthenia: diagnosis, treatment, and pathogenesis", Neurologist, 12, pp.231~239 (2006)[DOI]
- Palace J, "Myasthenia gravis: diagnostic and management dilemmas", Curr Opin Neurol, 14, pp.583~589 (2001)[DOI]
- Luchanok U, "Ocular myasthenia: diagnostic and treatment recommendations and the evidence base", Curr Opin Neurol, 21, pp.8~15 (2008)[DOI]
- Benatar M, "A systematic review of diagnostic studies in myasthenia gravis", Neuromuscul Disord, 16, pp.459~467 (2006)[DOI]
- Padua L, "SFEMG in ocular myasthenia gravis diagnosis", Clin Neurophysiol, 111, pp.1203~1207 (2000)[DOI]
- Barton JJ, "Ocular aspects of myasthenia gravis", Semin Neurol, 20, pp.7~20 (2000)[DOI]
- Park JY, "Diagnostic value of repeated ice tests in the evaluation of ptosis in myasthenia gravis", PLoS One, 12, pp.e0177078~ (2017)[DOI]
- Kim JH, "Childhood ocular myasthenia gravis", Ophthalmology, 110, pp.1458~1462 (2003)[DOI]
- Oh SJ, "Electromyography: Neuromuscular Transmission Studies", pp.1~304 (1988), Williams & Wilkins
- Putterman AM, "Margin reflex distance (MRD) 1, 2, and 3", Ophthal Plast Reconstr Surg, 28, pp.308~311 (2012)
- Jun AK, "MA statistical evaluation of the average value of margin reflex distance I and margin limbal distance in Koreans", J Korean Ophth Soc, 31, pp.1243~1248 (1990)
- Boboridis K, "Repeatability and reproducibility of upper eyelid measurements", Br J Ophthalmol, 85, pp.99~101 (2001)[DOI]
- Small RG, "The measurement and definition of ptosis", Ophthal Plast Reconstr Surg, 5, pp.171~175 (1989)[DOI]
- Parmar DN, "Oculoplastic Surgery: the Essentials", pp.512~ (2001), Thieme
- Cruz AA, "Quantification of palpebral fissure shape in severe congenital blepharoptosis", Ophthal Plast Reconstr Surg, 15, pp.232~235 (1999)[DOI]
- Cruz AA, "Digital image processing measurement of the upper eyelid contour in Graves disease and congenital blepharoptosis", Ophthalmology, 105, pp.913~918 (1998)[DOI]
- Flowers RS, "Diagnosing photographic distortion. decoding true postoperative contour after eyelid surgery", Clin Plast Surg, 20, pp.387~392 (1993)
- Choi CJ, "Margin reflex distance: differences based on camera and flash positions", Ophthal Plast Reconstr Surg, 32, pp.199~203 (2016)[DOI]