Intravitreous Methotrexate and Rituximab for Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP).

Area of Science:

• Ophthalmology
• Oncology
• Immunology

Background:

• Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP) is a rare paraneoplastic syndrome.
• BDUMP is often associated with rapid vision decline.
• Effective treatment options for BDUMP are limited.

Purpose of the Study:

• To evaluate the efficacy of intravitreous methotrexate and rituximab as a treatment for BDUMP.
• To assess the impact of this combination therapy on ocular structures and visual acuity.

Main Methods:

• Observational cohort study involving three patients (five eyes) with BDUMP.
• Combination injections of intravitreous methotrexate and rituximab administered as part of multimodal treatment.
• Optical coherence tomography (OCT) used to measure central foveal thickness (CFT) and subfoveal fluid (SFF).
• LogMAR/Snellen visual acuity recorded before and after treatment.

Main Results:

• Thirty-nine combination injections were administered.
• All eyes showed a decrease in CFT and SFF, and improved vision at some point.
• Median vision improvement was 5 Snellen lines; median CFT decrease was 243µm; median SFF decrease was 240µm.
• Four out of five eyes achieved significant and sustained vision improvement (20/25 or 20/20).

Conclusions:

• Intravitreous methotrexate and rituximab appear to be a well-tolerated and effective adjunctive treatment for BDUMP.
• The treatment led to notable improvements in ocular parameters and visual function.
• Outcomes in this cohort suggest a more favorable prognosis compared to the typical rapid vision loss associated with BDUMP.