Successful use of intravitreal rituximab as salvage therapy for relapsed vitreoretinal lymphoma

PURPOSE: To describe the outcomes, response patterns, and complications of intravitreal rituximab (IVR) in eyes with relapsed vitreoretinal lymphoma (VRL) despite previous treatment with ocular radiotherapy (EBRT). METHODS: Retrospective observational single-center study. This study included all patients diagnosed with relapsed VRL who received IVR between 2011 and 2024 at our National Ocular Oncology Service in the United Kingdom. Demographic data, systemic and ocular lymphoma history, treatment details, visual acuity, and ocular adverse events were collected from medical records. RESULTS: Ten eyes of six patients with relapsed VRL were treated with IVR. All eyes had been previously treated with ocular EBRT and with whole brain radiotherapy (WBRT) (83.3%) and systemic chemotherapy (66.7%) for CNS lymphoma. Eyes with relapsed VRL were treated with a mean of four IVR injections (1 mg/0.1 mL) per treatment course using weekly to monthly intervals. Complete ocular remission was achieved in all eyes after a single course of IVR. One eye experienced a further relapse 14 months later, successfully treated with a second course of IVR. Ocular adverse events potentially attributable to IVR included transient intraocular hypertension and mild uveitis; other complications, such as cataract, radiation retinopathy, and retinal atrophy were likely related to EBRT rather than IVR. CONCLUSION: In our cohort of relapsed VRL despite previous ocular EBRT, IVR used as a sole focal therapy was associated with high rates of ocular remission and acceptable local toxicity. These findings support the use of IVR as a standard salvage treatment in cases of relapsed VRL.