Clinical, Adaptive Optics Imaging and Electrophysiologic Outcomes in Autoimmune Retinopathy Patients with Rituximab

Abstract

Purpose : Given the proposed antibody-mediated of autoimmune retinopathy (AIR), rituximab as a therapeutic agent that targets B cells would seem reasonable. In this retrospective case series, we evaluate clinical and ancillary testing, including adaptive optics, outcomes in patients treated with rituximab.

Methods : 16 AIR patients (37.5 % male, mean age of 56 years) treated with rituximab were enrolled. The AIR diagnosis was based on clinical symptoms, electroretinogram (ERG) depression, presence of anti-retinal antibodies and exclusion of other diagnoses. All patients were treated initially with intravenous rituximab 375 mg/m² weekly for 4 weeks or 1000 mg every other week for two doses. Treatment was repeated every 6 months or sooner if the patients were worsening. Visual acuity (VA), ERG and spectral domain optical coherence tomography (SD-OCT) results were recorded. OCT characteristics examined included total macular volume (TMV) and central subfield macular thickness (CSMT). A subset of patients was also imaged using Adaptive Optics Scanning Laser Ophthalmoscopy (AO-SLO). Cone densities were measured in ten 150 × 150 µm² squares at each visit in the same locations at 1, 2 and 3 mm from the fovea. Outcomes before and six months after rituximab were compared with mixed model linear regression.

Results : Seven patients had paraneoplastic retinopathy and nine had non-paraneoplastic AIR. The mean follow-up period was 15 months (range 7-34 months) after rituximab initiation. 63% of eyes had stable VA during rituximab therapy. 14% of eyes experienced VA improvement. ERG parameters, CSMT and TMV did not decrease to a significantly degree over the rituximab treatment period. Six eyes had serial AO-SLO imaging. Cone densities did not change significantly over the treatment period.

Conclusions : VA was stable or improved in a majority of AIR patients while being treated with rituximab. OCT and ERG parameters, as well as AO-SLO cone densities, were stable during treatment. Studies with additional patients and longer follow up periods are needed to further explore the utility of rituximab in the management of AIR.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.