Secondary orbital and intraocular lymphoma treated with immunochemotherapy

To assess ocular and orbital structure by ocular echography and magnetic resonance imaging, fluoroangiography, indocyanine green angiography, and optical coherence tomography before and after therapy with rituximab (Mabthera) and chlorambucil in a patient with concurrent intraorbital and intraocular lymphoma and diplopia.

A 69-year-old man referred blurred vision and proptosis in his left eye associated with diplopia. Best-corrected visual acuity was 0.3 logarithm of the minimum angle of resolution in the left eye and 0.02 logarithm of the minimum angle of resolution in the right eye. Ocular echography and magnetic resonance imaging revealed the presence of concurrent orbital and intraocular tumor, and a B-cell lymphocytic lymphoma was diagnosed by incisional biopsy. The patient was treated with the oral alkylating agent chlorambucil and with intravenous infusions of the monoclonal anti-CD20 antibody rituximab (Mabthera) and evaluated with visual acuity, echography, fluoroangiography, indocyanine green angiography, and magnetic resonance imaging.

After combined immunochemotherapy with rituximab/chlorambucil, the patient showed in the left eye a significant improvement of visual acuity (0.1 logarithm of the minimum angle of resolution) and a disappearance of diplopia at the end of follow-up.

In this case report, combined systemic therapy with chlorambucil and rituximab was effective to reduce and control orbital and intraocular lymphoma.