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Use of intravitreal rituximab for treatment of vitreoretinal lymphoma
  1. Kelly L Larkin1,
  2. Ujwala S Saboo2,
  3. Grant M Comer3,
  4. Farzin Forooghian4,
  5. Friederike Mackensen5,
  6. Pauline Merrill6,
  7. H Nida Sen7,
  8. Arun Singh8,
  9. Rohan W Essex9,
  10. Stewart Lake10,
  11. Lyndell L Lim11,
  12. Daniel V Vasconcelos-Santos12,
  13. C Stephen Foster2,13,
  14. David J Wilson1,
  15. Justine R Smith1,10
  1. 1Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
  2. 2Massachusetts Eye Research and Surgery Institution, and Ocular Immunology and Uveitis Foundation, Cambridge, Massachusetts, USA
  3. 3Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
  4. 4Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
  5. 5Interdisciplinary Uveitis Centre, Department of Ophthalmology, Universitätsklinikum Heidelberg, Heidelberg, Germany
  6. 6Department of Ophthalmology, Rush University, Chicago, Illinois, USA
  7. 7National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
  8. 8Cleveland Clinic, Cleveland, Ohio, USA
  9. 9Department of Ophthalmology, Australian National University, Canberra, Australia
  10. 10Clinical & Molecular Medicine, Flinders University, Adelaide, Australia
  11. 11Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
  12. 12Department of Uveitis and Ophthalmic Pathology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  13. 13Department of Ophthalmology, Harvard University, Cambridge, Massachusetts, USA
  1. Correspondence to Professor Justine R Smith, Flinders University School of Medicine, Flinders Medical Centre Room 4E-431, Flinders Drive, Bedford Park, SA 5042, Australia; justine.smith{at}flinders.edu.au

Abstract

Aim Vitreoretinal lymphoma is a diffuse large B cell non-Hodgkin lymphoma. Targeting malignant cells with rituximab is being used increasingly as local chemotherapy, but information on this treatment is scant. We aimed to describe current therapeutic approaches, as well as responses to and complications of, intravitreal rituximab in patients with vitreoretinal lymphoma.

Methods Clinical data were collected in a standardised manner retrospectively on patients with vitreoretinal lymphoma treated with intravitreal rituximab.

Results 48 eyes (34 patients) with vitreoretinal lymphoma were treated with a median of 3.5 intravitreal injections of rituximab (1 mg/0.1 mL) for new diagnosis (68.8%), progressive disease (29.9%) and maintenance therapy (2.1%). Intravitreal rituximab±methotrexate was the sole treatment in 19 eyes (39.6%). 31 eyes (64.6%) eyes achieved complete remission, after a median of 3 injections; 7 of these eyes developed recurrent disease. 11 eyes (22.9%) achieved partial remission. Although rituximab may have contributed to complications reported in 12 eyes (25.0%), a 2-line loss of Snellen visual acuity occurred in only 2 of those eyes (4.2%).

Conclusions Approaches in rituximab-based intravitreal chemotherapy vary widely, but our findings suggest that this treatment may be safe and effective in inducing remission in a majority of eyes with vitreoretinal lymphoma.

  • Retina
  • Vitreous
  • Treatment Medical

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