• Neuro-Ophthalmology/Orbit

    This retrospective, interventional case series is the largest study to date assessing the effectiveness of rituximab for autoimmune retinopathy (AIR).

    Study design

    Investigators examined records from 16 AIR patients before and after they were treated with intravenous rituximab. All patients received loading and maintenance doses of rituximab, and were followed for at least 6 months (range 7–34 months).

    Outcomes

    Following rituximab therapy, 14% of eyes experienced improvement in visual acuity, 63% of eyes were stable and 23% showed worsening. Notably, the 2 patients who demonstrated significant visual gains were treated early in their disease course.

    The mean rate of visual decline improved from 0.032 logMAR units/month prior to rituximab initiation to 0.005 units/month in the 6 months following initiation (P=0.04). Visual fields, central subfield mean thickness and total macular volume remained unchanged.

    The authors observed infusion reactions in 4 patients.

    Limitations

    Study limitations include its retrospective nature, variable length of follow-up and patients who were treated at various stages of the disease.

    Additionally, in an accompanying editorial, Drs. Farzin Forooghian and Ian MacDonald discuss how the study was also likely underpowered to detect rare complications related to rituximab, which has previously been associated with serious and life-threatening adverse events.

    Clinical significance

    This study adds further evidence that rituximab is an effective therapy for a rare disease that is difficult to diagnose and treat.

    Although these results may be statistically significant, visual acuity gains appear modest. It remains to be determined if the benefits are clinically significant and justify the use of rituximab.