J Korean Ophthalmol Soc.  2012 May;53(5):721-727.

Three Cases of Rituximab Treatment for Orbital Inflammatory Disease

• Park BC
• Woo KI
• Kim YD

Abstract

PURPOSE
To report three cases of rituximab treatment in refractory orbital inflammatory disease.
CASE SUMMARY
Rituximab treatment was performed in three patients (thyroid-associated ophthalmopathy, orbital myositis, and idiopathic sclerosing inflammation) unresponsive to corticosteroid and radiotherapy. One cycle consisted of intravenous infusion of 1000 mg of rituximab, twice at a two-week interval. The patient with thyroid-associated ophthalmopathy exhibited clinical improvement in visual acuity, color vision, visual evoked potential, and visual field after one cycle of rituximab treatment. The patient with orbital myositis improved showed diplopia with a decrease in the size of the extraocular muscle after two cycles of treatment. The patient with idiopathic sclerosing inflammation showed improvements in visual acuity and visual field defect after one cycle of therapy. There were no severe infections or hematologic adverse effects including neutropenia, or decreased immunoglobulin during the follow-up period.
CONCLUSIONS
Treatment with rituximab appears to offer another therapeutic option in patients unresponsive to corticosteroid or radiotherapy.

Keyword

Inflammation; Orbit; Rituximab; Thyoid

MeSH Terms

Antibodies, Monoclonal, Murine-Derived
Color Vision
Diplopia
Evoked Potentials, Visual
Follow-Up Studies
Graves Ophthalmopathy
Humans
Immunoglobulins
Inflammation
Infusions, Intravenous
Muscles
Neutropenia
Orbit
Orbital Myositis
Visual Acuity
Visual Fields
Rituximab
Antibodies, Monoclonal, Murine-Derived
Immunoglobulins

Figure

• 

  Figure 1 Case 1. (A, C) Both eyes show conjunctival injection and proptosis. (B, D) Conjunctival injection in both eyes have markedly decreased after rituximab infusion. (E, G) Axial (E) and coronal (G) CT scans show marked fusiform enlargement of extraocular muscles in both sides. The coronal section shows compression of optic nerve in the orbital apex. (F, H) After rituximab infusion, apical crowding and stretching of optic nerve in the CT scan have improved. (I, J) Change in visual field before (I) and after (J) rituximab infusion.

• 

  Figure 2 Case 2. (A, B) Proptosis and upper lid swelling of the left eye before rituximab infusion (A) decreased after therapy (B). (C, E) Coronal CT scans show enlargement of the left superior oblique and medial rectus before rituximab treatment. (D, F) After rituximab treatment, muscle enlargement markedly decreased.

• 

  Figure 3 Case 3. (A, C) CT scans show infiltrative lobulated homogeneous mass in the left intraconal space. The optic nerve is involved by the orbital mass and displaced in the inferolateral direction. (B, D) After Rituximab infusion, orbital mass decreased and optic nerve infiltration improved.

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