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Rituximab for Primary Retinal Lymphoma

Marco A. Zarbin, MD, PhD
JAMA Ophthalmol. 2013;131(1):95. doi:10.1001/jamaophthalmol.2013.1874.
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Standard treatment for primary vitreoretinal lymphoma has included intravenous (as well as intrathecal) chemotherapy and radiation therapy. In addition, intravitreal chemotherapy, such as with methotrexate sodium, has been used. Not all patients respond to these interventions, and methotrexate can be associated with toxicity (eg, corneal epitheliopathy). Rituximab (Rituxan; Genentech) is a humanized monoclonal mouse anti-CD20 antibody approved for use as the initial treatment of B-cell non-Hodgkin lymphoma, including diffuse large B-cell lymphoma that is refractory to other chemotherapy regimens.1 The mechanism of action for this drug may involve induced apoptosis or complement/antibody-specific cytotoxic cell death. Because many cases of primary vitreoretinal and central nervous system lymphoma originate in B lymphocytes and express CD20 antigen on the cell surface, rituximab therapy may be beneficial. In small case series with limited follow-up, intravitreal rituximab has been used successfully to treat biopsy-proven CD20-positive primary vitreoretinal lymphoma.2,3

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