Is surgical intervention safe and effective in the treatment of myasthenic blepharoptosis? A multicenter survey in Japan.

neurological centers constituting the Japan MG Registry Study Group. All of the patients were interviewed about the clinical features of their MG and whether they had undergone blepharoptosis surgery. A total of 19 patients (2.8%; 7 men, 12 women; mean age: 65.7 years) had undergone blepharoptosis surgery, and were further evaluated by using a questionnaire. Questions regarding the timing of the surgery (relative to MG onset), the ease of eyelid opening [over both the short term ( ≤ 1 year) and long term (>1 year), postoperatively], aesthetic outcome (scarring), overall satisfaction with the surgery, and any noted complications. Three-point Likert scales were used to assess the ease of eyelid opening (much easier, easier, worse), scarring (very minimal, minimal, visible), and overall satisfaction with the surgery (very satisfied, satisfied, dissatisfied). To evaluate scarring, the patients answered the questionnaires with their attending neurologists in the out-patient clinics. The actual surgeons were not present to help in obtaining unbiased opinions from the patients. All clinical information was collected after the patients had provided written Dear Sir, Myasthenia gravis (MG) is an antibodymediated, neuromuscular transmission disorder. Its clinical manifestations range from ocular myasthenia, which can be visually disabling, to myasthenic crisis, with patients experiencing life-threatening respiratory insufficiencies [1] . Several effective medical treatments are available for the ocular symptoms of MG [2–6] ; however, physicians often struggle to treat patients with longstanding blepharoptosis [7–9] . Moreover, although blepharoptosis surgery is occasionally applied in such cases [10, 11] , the indications and clinical effectiveness of blepharoptosis surgery for MG patients remains unclear. In the present study, we retrospectively investigated the clinical features of blepharoptosis surgery by interviewing 19 Japanese patients with MG.