{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T11:07:29Z","timestamp":1783163249792,"version":"3.54.6"},"reference-count":47,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The role of thymectomy in ocular myasthenia gravis (OMG) remains controversial, particularly before secondary generalization. Methods: We conducted a multicenter retrospective study on 174 OMG patients who underwent thymectomy (112 OMG, 62 generalized OMG [g-OMG]). The primary endpoint was complete stable remission (CSR; MGFA-PIS criteria). Multivariable analyses identified predictors of CSR and generalization. Results: Mean age at surgery was 42.3 \u00b1 13.0 years; 53.4% were male. Thymoma was present in 29.3%. CSR was achieved in 18.9% overall, significantly higher in OMG (23.2%) compared to g-OMG (11.3%, p = 0.036), with 5-year CSR probabilities of 43% vs. 22% (p = 0.017). In non-thymomatous patients, 5-year CSR remained higher in OMG (41% vs. 17%, p = 0.010). Postoperative myasthenic crisis occurred exclusively in g-OMG (8.1%, p = 0.004). Multivariable analysis identified preoperative cholinesterase inhibitor monotherapy as an independent predictor of CSR (HR = 31.776, 95% CI: 4.188\u2013241.111, p = 0.001; non-thymomatous: HR = 19.746, 95% CI: 2.518\u2013154.849, p = 0.005). Minimally invasive techniques (78.6%) were associated with low morbidity (5.2%). Conclusions: Thymectomy during the purely ocular stage is associated with higher CSR rates and lower perioperative neurological risk than after generalization, particularly in non-thymomatous disease. Use of cholinesterase inhibitors as sole therapy prior to thymectomy independently predicts CSR. These findings support earlier surgical consideration in selected OMG patients and highlight the safety of minimally invasive approaches.<\/jats:p>","DOI":"10.3390\/jcm14217840","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T17:06:06Z","timestamp":1762362366000},"page":"7840","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Thymectomy in Ocular Myasthenia Gravis: Results Before and After Generalization and Prognostic Predictors of Outcomes"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2937-9678","authenticated-orcid":false,"given":"Dania","family":"Nachira","sequence":"first","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5563-0331","authenticated-orcid":false,"given":"Maria Teresa","family":"Congedo","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6399-9171","authenticated-orcid":false,"given":"Khrystyna","family":"Kuzmych","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Evoli","sequence":"additional","affiliation":[{"name":"Institute of Neurology, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Iorio","sequence":"additional","affiliation":[{"name":"Institute of Neurology, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7233-5809","authenticated-orcid":false,"given":"Maria Letizia","family":"Vita","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9659-1014","authenticated-orcid":false,"given":"Leonardo","family":"Petracca-Ciavarella","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9396-373X","authenticated-orcid":false,"given":"Adriana","family":"Nocera","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4654-1577","authenticated-orcid":false,"given":"Carolina","family":"Sassorossi","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Evangelista","sequence":"additional","affiliation":[{"name":"Departmental Unit of Molecular and Genomic Diagnostics, Genomics Core Facility, Gemelli Science and Technology Park (G-STeP), Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, 00168 Rome, Italy"},{"name":"Clinical Chemistry, Biochemistry and Molecular Biology Operations (UOC), Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8022-0083","authenticated-orcid":false,"given":"Paraskevas","family":"Lyberis","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University of Torino, 10124 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3166-1843","authenticated-orcid":false,"given":"Giovanni Maria","family":"Comacchio","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35129 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jury","family":"Brandolini","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Azienda Ospedaliera Universitaria Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8538-1719","authenticated-orcid":false,"given":"Vittorio","family":"Aprile","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3240-9313","authenticated-orcid":false,"given":"Carmelina Cristina","family":"Zifara","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9291-5619","authenticated-orcid":false,"given":"Maria Giovanna","family":"Mastromarino","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7409-8470","authenticated-orcid":false,"given":"Alexandro","family":"Patirelis","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, Tor Vergata University Polyclinic, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1664-9460","authenticated-orcid":false,"given":"Elena","family":"Asteggiano","sequence":"additional","affiliation":[{"name":"Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6785-4535","authenticated-orcid":false,"given":"Marco","family":"Anile","sequence":"additional","affiliation":[{"name":"Department of General and Specialistic Surgeries and Anesthesiology, Policlinico Umberto I, University of Rome Sapienza, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Venuta","sequence":"additional","affiliation":[{"name":"Department of General and Specialistic Surgeries and Anesthesiology, Policlinico Umberto I, University of Rome Sapienza, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6281-1800","authenticated-orcid":false,"given":"Andrea","family":"Imperatori","sequence":"additional","affiliation":[{"name":"Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Ambrogi","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, Tor Vergata University Polyclinic, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4890-2578","authenticated-orcid":false,"given":"Piergiorgio","family":"Solli","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Dell\u2019Amore","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35129 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9909-6820","authenticated-orcid":false,"given":"Marco","family":"Lucchi","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1773-8269","authenticated-orcid":false,"given":"Franca","family":"Melfi","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Pharmacy and Health and Nutrition Sciences, University of Calabria, 87036 Rende, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohsen","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Sant\u2019Andrea Hospital, \u201cSapienza\u201d University of Rome, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Ruffini","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University of Torino, 10124 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Rea","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of 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Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7189-5903","authenticated-orcid":false,"given":"Elisa","family":"Meacci","sequence":"additional","affiliation":[{"name":"Department of General Thoracic Surgery, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d, IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","article-title":"Myasthenia gravis","volume":"5","author":"Gilhus","year":"2019","journal-title":"Nat. Rev. Dis. 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