Intravitreal rituximab monotherapy for management of eyes with vitreoretinal lymphoma: initial experience from India.

PURPOSE: To evaluate treatment outcomes and complications of intravitreal rituximab (IVR) monotherapy for eyes with vitreoretinal lymphoma (VRL). METHODS: Patients diagnosed with 'isolated primary VRL' or 'VRL with remission of systemic disease' and treated with IVR (1 mg/0.1 ml) between June 2014 and June 2019 were included in this retrospective, interventional case series. Injections were repeated at monthly intervals until complete resolution. All patients signed a written informed consent form. Institutional review board approval was obtained. RESULTS: Twelve eyes of 7 patients with VRL were treated with 77 IVR injections at mean 6.42 injections per eye (median = 5; range = 2-13) for complete resolution at mean 8.16 ± 4.62 months (median = 6.97 months; range = 1.97-14.33 months). Mean age at presentation was 53.3 years (median = 54 years; range = 34-74 years). Patients were co-managed with medical oncologist and periodically evaluated. Complications included anterior uveitis (n = 6), raised intraocular pressure (n = 3), posterior synechiae (n = 2), vitreous haemorrhage (n = 1), pre-retinal haemorrhage (n = 1), retinal detachment (n = 1), posterior subcapsular cataract (n = 2) and sectoral iris atrophy (n = 1). Recurrences were seen in 3 eyes (25%), which eventually achieved complete resolution with treatment. None of the patients had systemic involvement or death during follow-up. Mean follow-up was 18.73 ± 8.83 months (median = 21.60 months; range = 7.37-32.67 months). CONCLUSION: Intravitreal rituximab monotherapy is effective in management of vitreoretinal lymphoma in patients with isolated ocular disease.

Clinical profile and outcomes of rhegmatogenous retinal detachment related to trauma in pediatric population.

OBJECTIVE: To analyze the outcomes of trauma-related rhegmatogenous retinal detachment (RD) in pediatric population. DESIGN: Retrospective observational series. PARTICIPANTS: All patients under 18 years of age who underwent surgery for RD following trauma from 2010 to 2018. METHODS: Data were recorded from medical records regarding type of trauma, ocular status at presentation, details of RD (extent, number of breaks, proliferative vitreoretinopathy, choroidal detachment). The surgical intervention (scleral buckling or vitrectomy; tamponade used) and postoperative outcomes, including anatomical success, resurgeries, and visual acuity, were noted. RESULTS: We included 32 eyes of 32 patients, where closed globe injury was seen in 13 eyes (41%) and open globe injury (OGI) in 19 eyes (59%). At presentation, 50% of the eyes had RD, with total RD in 20 eyes (63%). Scleral buckling was performed in 9 eyes (28%), whereas the remainder (n = 23) underwent pars plana vitrectomy with silicon oil tamponade for RD repair. Silicone oil removal was done in 16 eyes (70%) and recurrent or persistent RD was seen 17 eyes (53%). Final reattachment rate was 75% (n = 24). The final best-corrected visual acuity was better in the closed globe injury group (mean = 5/60 Snellen's vs 1/60 Snellen's in OGI group), though this was only marginally significant statistically. Late complications were seen in 26 eyes (81%), of which 18 (69%) had previous OGI. CONCLUSION: Pediatric traumatic RDs have very poor anatomical and visual outcomes. OGI fares worse than closed globe. Loss of vision in children can be prevented by better safety measures so as to avoid trauma.

Long-Term Outcomes of a Large Cohort of Patients with Eales' Disease.

PURPOSE: To analyze the long-term visual outcomes of Eales' patients. METHODS: A retrospective review of Eales' patients diagnosed between 1985 and 1995 with >10 years follow-up done. RESULTS: We included 500 patients (898 eyes) with mean follow-up duration of 15.8 years (10-25 years), and 81% patients had bilateral disease. Patients using oral steroid during acute stage disease had significantly better visual outcome at the final visit [0.42 logMar(6/18) ± 0.723 logMar(6/30)] compared to patients who did not receive oral steroids [(0.5907 logMar(6/24) ± 0.945 logMar(6/48)] (p = 0.004). Patients who received laser therapy had significantly better visual outcome at the final visit [(0.415 logMar(6/18) ± 0.66 logMar(6/30)] compared to those who did not undergo laser treatment [(0.9237 logMar(6/48) ± 1.31 logMar(6/120)] (p < 0.001). Poor presenting visual acuity and late stage of presentation were associated with poor visual outcome. Fifty-two percent of eyes had <5 recurrences over 10 years. CONCLUSION: Eales' disease is a bilateral recurrent retinal vasculitis disorder and timely treatment with steroid and/or laser photocoagulation result in better visual outcomes.