Risk factors for generalization of ocular myasthenia gravis

Purpose: To identify potential risk factors for the generalization of ocular myasthenia gravis (OMG). Design: Retrospective cohort study. Methods: This study was conducted at a tertiary neurology clinic between January 2007 and January 2018. A total of 209 patients with myasthenia gravis (MG) presenting with initial ocular involvement were included. Multivariable binary logistic regression was performed to assess the relationship between potential risk factors and disease generalization. Results: Generalization occurred in 65.6% of patients, while 34.4% remained with pure OMG during a median follow-up period of 74 months (range, 24–206 months). Among those who developed generalized MG (GMG), 84.7% did so within the first two years. The overall regression model was statistically significant ( p < 0.001), with a Nagelkerke R² value of 0.536, indicating a good model fit. Female sex, elevated acetylcholine receptor (AChR) antibody titers, and a positive repetitive nerve stimulation (RNS) test were identified as statistically significant predictors of disease generalization. Conclusions: The majority of patients with OMG develop generalized disease within the first two years. Major risk factors for generalization include female sex, elevated AChR antibody titers, and abnormal findings on RNS testing.