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Intralesional Rituximab for Primary Iris Lymphoma

Hakan Demirci, MD1; Joshua S. Grant, MD1; Victor M. Elner, MD, PhD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor
JAMA Ophthalmol. 2015;133(1):104-105. doi:10.1001/jamaophthalmol.2014.3303.
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Primary B-cell mucosa-associated lymphoid tissue (MALT) lymphoma of the iris is rare. The largest published series of 14 iris lymphomas included 3 such lymphomas.1 Thus, data concerning the effectiveness of treatment of these tumors are limited. External radiotherapy (the main treatment), resection, and systemic chemotherapy can cause substantial morbidity. Rituximab monoclonal antibody, targeting CD20 on B cells, has been used systemically and intralesionally to treat orbital and primary intraocular lymphomas and ocular inflammatory diseases.2,3 To our knowledge, we report the first case of primary iris MALT lymphoma treated with intralesional rituximab injection.

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Figure.
Iris Lymphoma of the Right Eye Before and After Therapy

A, Well-delineated, bilobed, vascularized, tan iris lesion. B, Anterior chamber angle involvement on gonioscopy. C, Ciliary body involvement on ultrasonographic biomicroscopy. D, Aspiration biopsy showing neoplastic medium-sized lymphocytes with hyperchromatic nuclei containing prominent nucleoli that contrast with small, reactive lymphocytes (hematoxylin-eosin, original magnification ×60). E, Numerous cells are CD20+ neoplastic B lymphocytes (immunohistochemistry, original magnification ×60). F, Few cells are reactive CD3+ T lymphocytes (immunohistochemistry, original magnification ×60). G, After 3 monthly intralesional rituximab injections, the tumor disappeared completely. H, The anterior chamber angle was free of tumor. I, No tumor was found on ultrasonographic biomicroscopy.

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Intralesional rituximab for primary iris lymphoma. JAMA Ophthalmol 2015;133(1):104-5.
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