Thymectomy in Ocular Myasthenia Gravis: Results Before and After Generalization and Prognostic Predictors of Outcomes

<b>Background:</b> The role of thymectomy in ocular myasthenia gravis (OMG) remains controversial, particularly before secondary generalization. <b>Methods:</b> 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. <b>Results:</b> 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%, <i>p</i> = 0.036), with 5-year CSR probabilities of 43% vs. 22% (<i>p</i> = 0.017). In non-thymomatous patients, 5-year CSR remained higher in OMG (41% vs. 17%, <i>p</i> = 0.010). Postoperative myasthenic crisis occurred exclusively in g-OMG (8.1%, <i>p</i> = 0.004). Multivariable analysis identified preoperative cholinesterase inhibitor monotherapy as an independent predictor of CSR (HR = 31.776, 95% CI: 4.188-241.111, <i>p</i> = 0.001; non-thymomatous: HR = 19.746, 95% CI: 2.518-154.849, <i>p</i> = 0.005). Minimally invasive techniques (78.6%) were associated with low morbidity (5.2%). <b>Conclusions:</b> 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.

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Journal
Journal of Clinical Medicine
Published
2025-11-04
DOI
https://doi.org/10.3390/jcm14217840
Primary Topic
Myasthenia Gravis and Thymoma
Type
article
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article

Thymectomy in Ocular Myasthenia Gravis: Results Before and After Generalization and Prognostic Predictors of Outcomes

Marco Lucchi, Vincenzo Ambrogi, Adriana Nocera, Enrico Ruffini et al.
Journal of Clinical Medicine
Myasthenia Gravis and Thymoma
article

Thymectomy in Ocular Myasthenia Gravis: Results Before and After Generalization and Prognostic Predictors of Outcomes

Marco Lucchi, Vincenzo Ambrogi, Adriana Nocera, Enrico Ruffini, Raffaele Federico Iorio, Maria Giovanna Mastromarino, Maria Letizia Vita, Franca Melfi, Khrystyna Kuzmych, Jury Brandolini, Carmelina Cristina Zirafa, Mohsen Ibrahim, Elisa Meacci, Federico Rea, Andrea Imperatori, Paraskevas Lybéris, Piergiorgio Solli, Alexandro Patirelis, Giovanni Maria Comacchio, Maria Teresa Congedo, Leonardo Petracca-Ciavarella, Andrea Dell’Amore, Vittorio Aprile, Dania Nachira, Stefano Margaritora, Jessica Evangelista, Carolina Sassorossi, Marco Anile, Federico Venuta, Amelia Evoli, Elena Asteggiano
article en

Abstract

<b>Background:</b> The role of thymectomy in ocular myasthenia gravis (OMG) remains controversial, particularly before secondary generalization. <b>Methods:</b> 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. <b>Results:</b> 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%, <i>p</i> = 0.036), with 5-year CSR probabilities of 43% vs. 22% (<i>p</i> = 0.017). In non-thymomatous patients, 5-year CSR remained higher in OMG (41% vs. 17%, <i>p</i> = 0.010). Postoperative myasthenic crisis occurred exclusively in g-OMG (8.1%, <i>p</i> = 0.004). Multivariable analysis identified preoperative cholinesterase inhibitor monotherapy as an independent predictor of CSR (HR = 31.776, 95% CI: 4.188-241.111, <i>p</i> = 0.001; non-thymomatous: HR = 19.746, 95% CI: 2.518-154.849, <i>p</i> = 0.005). Minimally invasive techniques (78.6%) were associated with low morbidity (5.2%). <b>Conclusions:</b> 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.

Journal of Clinical MedicineVol. 14(21)
Università Cattolica del Sacro Cuore (IT), University of Insubria (IT), University of Padua (IT), Policlinico Umberto I (IT), Agostino Gemelli University Polyclinic (IT), 5T Torino (Italy) (IT), Azienda USL di Bologna (IT), Torino e-district (IT), Policlinico Tor Vergata (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), Azienda Ospedaliera Universitaria Pisana (IT), University of Calabria (IT), University of Turin (IT), Sapienza University of Rome (IT)
Openalex Percentile: Top 54%
Myasthenia Gravis and Thymoma
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