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Case Reports
. 2022 Oct 11;7(2):160-164.
doi: 10.1177/24741264221123440. eCollection 2023 Mar-Apr.

Intravitreal Rituximab-Associated Retinal Occlusive Vasculitis

Mark A McAllister  1 , Spencer M Moore  1 , April E Harris  1   2
Affiliations
Case Reports

Intravitreal Rituximab-Associated Retinal Occlusive Vasculitis

Mark A McAllister et al. J Vitreoretin Dis. .

Abstract

Purpose: To describe a 90-year-old patient who was referred to a private retina specialist with gradually worsening vision and floaters in the left eye.

Methods: A retrospective case report is presented.

Results: The patient was treated with intravitreal rituximab injections for intraocular lymphoma with resulting vision loss to the level of hand motions from severe granulomatous uveitis and retinal occlusive vasculitis.

Conclusions: Retinal occlusive vasculopathy secondary to rituximab intravitreal injections is a rare clinical entity with only a single previous case reported in the literature. However, there are reports of systemic vasculitis after systemic administration of rituximab. Clinicians should be aware of the possibility of ocular hypertension, granulomatous anterior uveitis, and/or retinal occlusive vasculitis after intravitreal rituximab use. Consideration should be given to the inflammatory risk of rituximab intravitreal injections to reduce the potential for treatment-induced vision loss.

Keywords: intravitreal rituximab; retinal vasculitis; vasculopathy.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Widefield color fundus photograph of left eye after administration of intravitreal rituximab. Note the evidence of occlusive vasculopathy along the superotemporal arcade and along vessels nasal to the disc with intraretinal hemorrhages. There are peripheral superotemporal laser scars from previous laser retinopexy for a horseshoe retinal tear.
Figure 2.
Figure 2.
Midphase widefield fluorescein angiography of the left eye shows the retinal occlusive vasculopathy along the superotemporal arcade and nasal to the disc. There is greater visualization of distal occlusion of superotemporal vessels as well. No hyperfluorescence or neovascularization is present.
Figure 3.
Figure 3.
Three weeks after IVR with treatment of topical steroids. Note the improved perfusion along the superotemporal arcade. There is persistent occlusive vasculopathy of vessels nasal to the disc.
Figure 4.
Figure 4.
Color fundus photograph of the left eye after the third intravitreal rituximab injection. There are new hemorrhages along the superotemporal arcade and the vessels nasal to the disc. The details of the retina and vessels are obscured by the vitritis, although the vessels appear as though they might be attenuated.
See this image and copyright information in PMC

References

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