重症肌無力症之眼科觀察

Ocular Manifestations of Myasthenia Gravis

翁林仲(Lin-Chung Woung) ； 周文穎(Wen-Ying Chou) ； 柯良時(Liang-Shi Ko) ； 邱浩彰(Hou-Chang Chiu)

《中華民國眼科醫學會會刊》 24卷2期 (1985/05) Pp. 325-334

https://doi.org/10.30048/ACTASOS.198505.0056

摘要

民國五十九年至七十二年台大醫院診斷肌無力症病患共543例，以其中197例追踪檢查分析，乎均觀察時間為四年半。病人分為三型，一為眼型(Ocular type)，二為由眼型轉變為全身型(Generalized type)，三為先有全身症狀再發生眼症狀。
平均罹病年齡31.5%病患小於10歲，而以眼型發病年齡最輕。眼科醫師發現並診斷此病的機會很多，眼型中之58%病患最先找眼科。眼瞼下垂是重要症狀，有38%病人其下垂是單側發生。病發當時即有眼部症狀者共有85.7%。外眼肌受影響，以三條肌肉以上同時受影響最多。診斷方面，以Neostigmine、Edrophonium，輔以E.M.G．連續電刺激為最佳。治療上，眼型仍以Anticholinesterase為主，再輔以間日投與類固醇。由眼型轉變為全身型的病例中有73%在一年內發生轉型。弱視的發生和肌無力症的關係，以瞼裂大小、發病年齡、治療開始時間並斜視之有無為主。特別要注意者為除外眼肌障碍外，肌無力症病患之瞳孔反應週期(pupil cycle time)有明顯延長之現象。

並列摘要

A retrospective study of 197 patients with myasthenia gravis was carried out in order to identify the differences in incidence, age, sex distribution, and prognosis between the western and Chinese patients. There were 78 males and 119 females. The average follow-up time was 4.5 years.
Concerning the onset age, 31.5% patients had their onset before 10 years old. The average onset age of the ocular type was 17 y/o, and of the ocular-systemic type 26.7 y/o.
The ophthalmologists had a good opportunity to detect the myasthenia gravis patients, because 38% of the 197 patients or 58% of the 110 ocular type patients had their first visit to eye doctors.
At the onset, out of 85.7% of the 197 patients, 31.5% had ocular symptoms and other signs, 54.2% had only ocular involvement. Ptosis was the most frequent complaint, involving both eyes in 62.3% of the 197 patients. The severity of the ptosis was moderate, that is, about 75.8% of ptotic lids' fissures were less than 5 mm. The limitation of eye ball movement occurred most commonly after three or more extraocular muscles were involved. In the cases where a single muscle was involved, impairment of the lateral rectus muscle was most frequently seen.
More than half of the patients (57.4% were diagnosed by neostigmine test, and the remaining 29.9% by E.M.G. and the repetitive stimulation test. Anticholinesterase is still the first drug choice for the treatment of ocular myasthenia gravis patients; if combined on alternate days with prednisolone, the effect on eyeball impairment will be much greater.
The onset age is one of the important factors causing the impairment of the visual acuity of myasthenia gravis patients. In addition, the lid fissure, the beginning of treatment time, and the presence of strabismus should also be taken into consideration. The mean pupil cycle time of the myasthenia gravis patients is 1453.9 msec, apparently more prolonged than that of normal controls (912.6 msec). The type classification of myasthenia gravis, the onset age, and the duration of the disease may cause pupillary dysfunction in several different ways.
Most patients (72.9%) had their transition time from ocular to systemic type within one year. A few patients transited more than 2 years. The remission rate of 197 cases was 20.3%, with the average remission period being 1.5 year.

並列關鍵字

myasthenia gravis ； ocular-generalized type ； amblyopia ； pupil cycle time