Ocular Symptoms Are Persistent in AChR Antibody‐Positive Generalized Myasthenia Gravis: A Single Center Study Quantified by an Ocular Index

Introduction/Aims Ocular symptoms are prevalent and exacerbate the disease burden among patients with myasthenia gravis (MG). However, their detection and therapeutic strategies are frequently neglected. The aim of this study is to demonstrate the relative burden of ocular symptoms throughout the treatment course of MG. Methods We conducted a retrospective, longitudinal registry‐based study at Huashan Hospital, Fudan University, involving 93 treatment‐naive patients with acetylcholine receptor antibody‐positive (AChR+) MG, and collected their clinical manifestations and pharmacological treatment measures. Myasthenia Gravis Ocular Index (MGOI) of Myasthenia Gravis Activities of Daily Living (MG‐ADL), quantitative myasthenia gravis (QMG), myasthenia gravis composite (MGC), and Myasthenia Gravis Quality of Life 15‐item (MG‐QoL‐15) at baseline and at the 2‐year follow‐up, as well as ΔMGOI, the difference between each pair of MGOIs, were calculated. And a subgroup of 46 patients from this cohort with a follow‐up duration of 4 years was utilized for long‐term validation. Results The study found that despite a decline in both ocular and nonocular scores, MGOI for MG scales (ΔMGOI‐MG‐ADL: 0.10 ± 0.35, p < 0.001; ΔMGOI‐QMG: 0.04 ± 0.27, p > 0.05; ΔMGOI‐MGC: 0.15 ± 0.35, p < 0.001; ΔMGOI‐QoL‐15: 0.07 ± 0.29, p < 0.05) increased in the 2‐year follow‐up, indicating a relative escalating ocular burden compared with other muscle groups. A relative deceleration in MGOI change was observed between the second and the third follow‐ups (in the second year). For MGOI‐MGC, nonsteroid immunosuppressants (ΔMGOI‐MGC: 0.20 ± 0.37, p < 0.05) or prednisone treatment (ΔMGOI‐MGC: 0.16 ± 0.35, p < 0.05) were correlated with a more significant elevation. The long‐term follow‐up subcohort (0–4 years) validated the persistent increase in MGOI‐ADL (0.18 ± 0.42, p < 0.05) and MGOI‐MGC (0.19 ± 0.37, p < 0.001). Discussion Ocular symptoms are persistent in patients with MG, which might be related to the anatomical and physiological characteristics of extraocular muscles and their responsiveness to treatment.