Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI.
Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI.
Can J Ophthalmol. 2024 Oct;59(5):e496-e500. doi: 10.1016/j.jcjo.2023.10.016. Epub 2023 Nov 20.
To evaluate the efficacy of intralesional rituximab injection for the management of idiopathic orbital inflammation (IOI) involving the lacrimal gland, which is the most common subtype.
Eighteen consecutive patients with biopsy-proven IOI involving the lacrimal gland were included. Rituximab (50 mg/5 mL) was injected intralesionally at monthly intervals.
Clinically, all patients presented with upper eyelid swelling and ptosis. Most patients (56%) had periocular pain and a palpable superotemporal mass. Biopsies showed chronic inflammation without fibrosis in 14 patients (78%) and chronic inflammation and fibrosis in 4 patients (22%). Intralesional rituximab was injected once in 1 patient (6%) because of complete response after the first injection, twice in 11 patients (61%), and 3 times in 6 patients (33%) because of partial response after 2 injections. After a mean follow-up of 33 months (median, 33 months; range, 11-59 months), 16 patients (89%) showed a clinical response, including 14 patients (78%) a complete response (i.e., disappearance of all lesions) and 2 patients (11%) with a partial response (i.e., ≤30% decrease in lesion diameter). Two patients (11%) did not respond after 3 injections and were placed on systemic corticosteroid and methotrexate therapies. Two patients (11%) with a complete response developed subsequent recurrence 12 and 49 months after their last injections. Both were treated with 2 additional rituximab injections, 1 month apart, and showed complete response when examined 27 and 11 months after treatment, respectively.
Intralesional rituximab injection may be an effective treatment for IOI involving the lacrimal gland, achieving a 78% complete response rate in this series. Local treatment with rituximab has the potential to avoid the ocular and systemic side effects of corticosteroid and systemic immunosuppressive treatment.
评估病灶内利妥昔单抗注射治疗累及泪腺的特发性眼眶炎症（IOI）的疗效，这是最常见的亚型。
纳入 18 例经活检证实累及泪腺的 IOI 患者。利妥昔单抗（50mg/5mL）每月病灶内注射一次。
临床上，所有患者均以上眼睑肿胀和下垂就诊。大多数患者（56%）有眼眶疼痛和可触及的眶上极肿块。14 例患者（78%）活检显示无纤维化的慢性炎症，4 例患者（22%）活检显示慢性炎症伴纤维化。1 例患者（6%）因首次注射后完全缓解而仅接受 1 次病灶内利妥昔单抗注射，11 例患者（61%）接受 2 次，6 例患者（33%）因 2 次注射后部分缓解而接受 3 次注射。平均随访 33 个月（中位数 33 个月；范围 11-59 个月）后，16 例患者（89%）出现临床缓解，包括 14 例患者（78%）完全缓解（即所有病变完全消失）和 2 例患者（11%）部分缓解（即病变直径减少≤30%）。2 例患者（11%）在接受 3 次注射后无反应，接受全身皮质类固醇和甲氨蝶呤治疗。2 例完全缓解患者在末次注射后 12 个月和 49 个月分别出现后续复发。两者均接受了 2 次额外的利妥昔单抗注射，间隔 1 个月，分别在治疗后 27 个月和 11 个月时检查发现完全缓解。
病灶内利妥昔单抗注射可能是累及泪腺的 IOI 的有效治疗方法，本研究系列中完全缓解率为 78%。局部使用利妥昔单抗有可能避免皮质类固醇和全身免疫抑制治疗的眼部和全身副作用。
