Ocular adnexal lymphomas constitute 2% of all non-Hodgkin’s disease and 5-15% of all extranodal lymphomas and are usually localised, low-grade and of B-cell origin. This opens them up to potential treatment with a systemic monoclonal antibody-based drug (rituximab) directed at CD20- a B-cell marker. Hitherto these lymphomas have been treated with surgical resection, cryotherapy, antiobiotics, interferon and radiotherapy. However, these treatments can cause ocular side-effects, in particular for the case of radiotherapy. Whilst rituximab has been used for lymphomas for many years, its use in primary ocular adnexal lymphoma is limited. This group therefore evaluated its systemic use in 10 consecutive patients with primary lymphoma. Patients were given 375mg/m2 iv three-weekly for 6-8 cycles. MRI and PET scanning were used to evaluate responses. Patients were aged between 27 and 85 years and 90% presented with conjunctival involvement and without systemic manifestations. Thirty-six percent had complete remission without recurrence over 31 months from rituximab alone. None had ocular or systemic side-effects, however 64% required additional radiotherapy. The authors concluded that given the low rate of side- effects and significant response rate, rituximab may be considered an initial primary treatment for CD20 positive ocular adnexal lymphoma.

Systemic rituximab immunotherapy in the management of primary ocular adnexal lymphoma single institutional experience.
Tuncer S, Tanyildiz B, Basaran M, et al.
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Jonathan CP Roos

Harvard, Cambridge & Moorfields-trained Consultant Oculoplastic Surgeon and academic based in London at www.FaceRestoration.com. Publishes in the world’s leading medical journals and lectures internationally on aesthetics, eyelid diseases and thyroid eyes.

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