Robotic thymectomy for ocular myasthenia gravis: a case series from a UK tertiary centre.

Background: Ocular myasthenia gravis (oMG), characterised by ptosis and diplopia, may progress to generalised MG (gMG). Thymectomy is established for seropositive gMG, but its role in oMG remains unclear. Robotic-assisted thoracoscopic surgery (RATS) offers minimally invasive advantages, yet outcomes in oMG are understudied. This case series describes the outcomes of seven patients at University College London Hospitals (UCLH) (2019-2025) undergoing robotic thymectomy for oMG. Methods: We describe seven oMG patients undergoing robotic thymectomy at UCLH (2019-2025), focusing on improvement in daily life using the MG activities of daily living (MG-ADL) score and medication reduction. Results: Patients showed significant pyridostigmine reduction (mean decrease: 246 mg) and improved MG-ADL scores (mean=4.00 to 0.57) with no major complications. No patients progressed to gMG. Conclusion: We saw robotic thymectomy (RATS) reduce pyridostigmine dependence and improve quality of life (MG-ADL) in the seven oMG patients, with no complications. These cases demonstrated successful cases of RATS as a transformative, minimally invasive option for early MG. While thymectomy may reduce the risk of generalisation, further multicentre studies are needed. Careful patient selection remains critical, but RATS may expand feasibility in oMG.