Hashida Noriyasu, Ohguro Nobuyuki, Nishida Kohji
Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan.
Transl Vis Sci Technol. 2012 Oct 22;1(3):1. doi: 10.1167/tvst.1.3.1. eCollection 2012.
To assess the long-term clinical outcomes of intravitreal injections of rituximab (IVR), an anti-CD20 monoclonal antibody, to treat CD20-positive primary vitreoretinal lymphoma (PVRL).
Twenty eyes of 13 women (mean age, 66.2 ± 9.9 years) with CD20-positive PVRL were included in this prospective, interventional case series. All patients had discontinued previous intravitreal methotrexate (IVM) treatment because of severe corneal epitheliopathy. Weekly IVR injections (1 mg/0.1 ml) for 4 weeks were administered as a one-course protocol. Additional injections were administered when the PVRL recurred. The effects and the adverse events associated with IVR injections were evaluated.
All patients completed a 1-year follow-up (mean observation after IVR injections, 24.7 ± 6.3 months). Before treatment, diffuse keratic precipitates (KPs), anterior vitreous cells, or both were observed in 18 (90%) eyes of 11 patients, and typical subretinal infiltrates were seen in eight (40%) eyes of six patients; all improved with one treatment course. The anterior segment lesions recurred in 11 (55%) eyes of nine patients and resolved with another course of injections. Transient IOP elevations occurred in 12 (60%) eyes of 10 patients within 3.8 ± 1.9 weeks after the first treatment course; iridocyclitis with mutton-fat KPs developed in seven (35%) eyes of six patients with elevated IOP and resolved with topical treatment. No other significant ocular complications or systemic side effects developed.
Injections of IVR were shown to be an efficacious alternative treatment for PVRL, although the disease recurred in approximately half of the eyes. Complications included transient IOP elevations and iridocyclitis with mutton-fat KPs that were managed topically.
The results of this trial support IVR as one element of combined modality therapy for treating PVRL patients without CNS involvement, particularly for those who respond poorly and have side effects with IVM. (http://www.umin.ac.jp/ctr/ number, UMIN000005604).
评估玻璃体内注射利妥昔单抗（IVR），一种抗CD20单克隆抗体，治疗CD20阳性原发性玻璃体视网膜淋巴瘤（PVRL）的长期临床疗效。
本前瞻性、介入性病例系列纳入了13名女性（平均年龄66.2±9.9岁）的20只患有CD20阳性PVRL的眼睛。所有患者因严重角膜上皮病变而停止了先前的玻璃体内甲氨蝶呤（IVM）治疗。按照一个疗程方案，每周注射IVR（1mg/0.1ml），共4周。当PVRL复发时给予额外注射。评估与IVR注射相关的疗效和不良事件。
所有患者均完成了1年的随访（IVR注射后的平均观察时间为24.7±6.3个月）。治疗前，11名患者的18只眼睛（90%）观察到弥漫性角膜后沉着物（KPs）、前玻璃体细胞或两者皆有，6名患者的8只眼睛（40%）观察到典型的视网膜下浸润；经过一个疗程的治疗，所有这些情况均得到改善。9名患者的11只眼睛（55%）前段病变复发，再次注射一个疗程后病变消退。10名患者的12只眼睛（60%）在第一个疗程治疗后3.8±1.9周内出现短暂性眼压升高；6名眼压升高患者的7只眼睛（35%）发生伴有羊脂状KPs的虹膜睫状体炎，局部治疗后消退。未出现其他严重的眼部并发症或全身副作用。
尽管约一半的眼睛疾病复发，但IVR注射被证明是PVRL的一种有效替代治疗方法。并发症包括短暂性眼压升高和伴有羊脂状KPs的虹膜睫状体炎，这些可通过局部治疗控制。
本试验结果支持IVR作为治疗无中枢神经系统受累的PVRL患者联合治疗模式的一个组成部分，特别是对于那些对IVM反应不佳且有副作用的患者。（http://www.umin.ac.jp/ctr/编号，UMIN000005604）
