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Abstract Details

Efficacy of Apraclonidine in Treating Ptosis Secondary to Myasthenia Gravis
Neuromuscular and Clinical Neurophysiology (EMG)
P6 - Poster Session 6 (5:30 PM-6:30 PM)
Most patients with MG develop ocular manifestations and up to 15% may have isolated ocular myasthenia. Eyelid elevation is a function of two muscles: Levator Palpebrae Superioris and Superior Tarsal muscle or Muller muscle, a smooth muscle innervated by the sympathetic nervous system. Muller muscle is spared from the effects of the antibodies directed against the skeletal muscles in MG. Apraclonidine elevates the eyelid by activating alpha-2 receptors on Muller muscle. Apraclonidine can spare patients from the numerous side effects associated with standard treatment like immunosuppressants. 
To evaluate the effect of Apraclonidine in alleviating ptosis secondary to myasthenia gravis (MG).
This is a pilot clinical trial conducted at the American university of Beirut medical center. Patients with ptosis secondary to MG were administered 2 drops of Apraclonidine 0.5% solution to the most affected eye. We measured eyelid parameters including palpebral fissure height (PF), marginal reflex distance-1 (MRD1), marginal reflex distance-2 (MRD2), and levator function (LF) before drug administration and at 1, 5, 30, and 60 minutes post administration.

10 participants were enrolled. Enhancement in all eyelid measurements was noted in all participants, as early as 1 minute after the administration of Apraclonidine. Average PF increased from 8.8 ±1.8 millimeters (mm) before the administration of Apraclonidine to 14.2 ± 2.61 mm at 60 minutes after administration. MRD-1 increased from 1.7 ±1.4 mm to 5.4 ± 2.8 mm; MRD-2 increased from 7.1 ±1.3 mm to 8.8 ± 1.6 mm; LF increased from 13.4 ± 2.9 mm to 17.5 ± 2.4 mm. The percentage increase in PF rose from 29% at 1 minute to 63% at 60 minutes post administration; MRD-1 from 72% to 214%; MRD-2 from 17% to 27%; LF from 16% to 34%.

Apraclonidine may be an effective and safe alternative treatment for patients with ptosis secondary to MG.
Mohamad Khodr Agha, MD
Dr. Khodr Agha has nothing to disclose.
No disclosure on file
Raja Sawaya, MD (American University of Beirut) Dr. Sawaya has nothing to disclose.
Johnny Salameh, MD, FAAN Dr. Salameh has nothing to disclose.