1. Department of Neurology, University of California at Irvine, USA.
Primary intraocular lymphoma (PIOL) is rare malignancy affecting the eyes. It is a type of B cell malignancy, although T-cell type PIOL has been reported. PIOL is closely associated with primary CNS lymphoma (PCNSL). As many as 20% of PCNSL eventually get PIOL, while as many as 80% of PIOL patients develop CNS disease. Primary intraocular lymphoma can mimic non-neoplastic processes in the eye, such as vitreatis or uveitis. The diagnosis of PIOL is difficult. It can be performed by cytology, immnohistochemistry, flow cytometry, cytokine profiling or molecular detection of rearranged genes. The treatment of PIOL remains controversial. Some centers prefer radiation therapy, others use intravitreal chemotherapeutic injections. It is believed that the chemotherapy and radiation stop the progression of lymphoma, but does very little for preventing the development of CNS disease. In recent years, intravitreal injections gained popularity due to poor penetration of the systemic chemotherapy into the eye. Rituximab is a humanized antibody which targets CD-20 positive B cells and has been successfully used in the treatment of PIOL with minimal side effects. In this paper we present the case of a sixty year old woman who developed primary intraocular lymphoma, after treatment for her recurrent CNS lymphoma. Intravitreal injections of rituximab led to stabilization of visual symptoms and vision preservation. Currently the patient is doing well two years after treatment. We believe that further studies investigating the outcomes in patients receiving intravitreal injection of rituximab compared to intravitreal injection of methotrexate are warranted.
Key words: Rituximab, primary intraocular lymphoma, intravitreal rituximab, temozolomide