S-Space College of Medicine/School of Medicine (의과대학/대학원) Dept. of Medicine (의학과) Theses (Master's Degree_의학과)
Diagnostic value of repeated ice tests in the evaluation of ptosis in myasthenia gravis
안검하수를 동반한 중증근무력증에서 반복된 Ice test의 진단적 가치
- 박준영, 양희경, 황정민
- 의과대학 의학과
- Issue Date
- 서울대학교 대학원
- 학위논문 (석사)-- 서울대학교 대학원 : 의학과 안과학, 2016. 2. 황정민.
TITLE: Diagnostic Value of Repeated Ice Tests in the Evaluation of Ptosis in
PURPOSE: To determine the repeatability and diagnostic value of the ice test in
the evaluation of ptosis in myasthenia gravis (MG).
DESIGN: Retrospective review.
METHODS: Twenty-six patients with ptosis related to MG and 38 controls with
ptosis other than MG were included. All patients were tested with the ice test 2
times on separate days in the afternoon. The margin reflex distance (MRD) was
measured before and immediately after 2-minute application of ice on the eyelids.
The ice test was judged positive if there was an improvement of at least 2.0 mm
MRD after the ice test. 'Equivocalwas defined by improvement of MRD from at
least 1.0 mm to less than 2.0 mm after the ice test.
RESULTS: Repeated ice tests showed an agreement of 61.5% in MG, and 97.4%
in nonmyasthenic ptosis. Repeated ice tests increased the positive predictive
value by 2.7%, the negative predictive value by 11.6% and sensitivity by 26.9%
compared to a single test. Among the patients with repeatedly negative test
results, 63.7% of those who showed equivocal results at least once turned out to
be MG. Of those with repeated non-equivocal negative results, nobody turned
out to be MG. There was no statistically significant difference of the results of the
ice test between ocular MG and generalized MG (p = 0.562).
CONCLUSIONS: The repeatability of the ice test was 61.5% in myasthenic
ptosis. Repeated ice tests enhanced the sensitivity of the test by 27% compared
to a single test. Patients with an equivocal negative result had a 64% chance to