Myasthenia gravis
ICD-10 G70.0 · ICD-11 8C60

Ocular Myasthenia Gravis with Ophthalmoparesis or Ptosis — When Corticosteroids Did Not Achieve Sustained Minimal Manifestation

This protocol addresses patients with ocular MG presenting with ophthalmoparesis or ptosis who completed an initial corticosteroid-based immunosuppressant course but did not reach sustained minimal manifestation (MM) status, requiring a next-line approach.

Previous treatment & failure condition

The preceding line used corticosteroids as the initial immunosuppressant agent — including low-dose strategies to limit side-effect burden. This protocol is triggered when that course failed to produce sustained minimal manifestation status.

Clinical scenario

Ocular MG restricted to ophthalmoparesis or ptosis that is functionally limiting or troublesome, where immunosuppressant therapy is indicated and the corticosteroid-based first line has proven insufficient.

Treatment approach (partial)

The escalation step involves a class of steroid-sparing immunosuppressant agents. Agent selection, monitoring parameters, and the full sequencing algorithm are contained in the complete protocol.

Treatment goal

Complete resolution of ophthalmoparesis.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1212/WNL.0000000000011124

Ophthalmoparesis or ptosis in ocular MG that is not responding to anticholinesterase agents should be treated with immunosuppressant agents if symptoms are functionally limiting or troublesome to the patient.

Steroid-sparing IS agents may be needed when corticosteroids alone are ineffective, contraindicated, or not tolerated.

Fifty-nine percent of patients had complete resolution of ophthalmoparesis within 12 ± 2 months of initiation of IS agents. Median time to resolution was 7 months after IS agents were started.

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