Objective: To observe the efficacy of intralesional rituximab administration in primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (POAML). Methods: Retrospective case series study. The clinical and follow-up data of eight patients with POAML in the treatment group from September 2017 to December 2018 at the First Affiliated Hospital of Zhengzhou University were collected and analyzed retrospectively. The patients (3 males and 5 females) were 35 to 83 years old, with a median of 58 years. All patients received surgical treatment (most of the tumor were removed). The diagnosis of mucosa-associated lymphoid tissue lymphoma was confirmed by histopathology and immunohistochemical staining showed CD20+. Examinations such as chest CT, abdominal CT, bone marrow biopsy or positron emission tomography-CT to exclude lymphoma with systemic lesions. Patients with conjunctival POAML were injected through the subconjunctival infiltration. For the lacrimal gland POAML and the orbital POAML, the injection was performed through the periocular space by using a post-bulb syringe needle at multi-points with an interval of 1 cm, before the pressure dressing. All patients were injected 1.5 to 5.0 ml (15 to 50 mg) once every three weeks, 4 to 6 times as a treatment cycle. The injection range included or exceeded the lesion area. Then consider whether to supplement the number of treatments based on the remaining tumor. The patients' treatment doses, drug onset time, tumor regression, local reactions (local pain and swelling), systemic reaction indicators (fever, gastrointestinal reactions, complete blood count and the lymphocyte subsets), and systemic recurrence indicators (serum β2 microglobulin and lactate dehydrogenase detecting) were recorded. Results: Two patients, including one patient with bilateral lesions, had conjunctival POAML, one patient had lacrimal gland POAML, and five patients had orbital POAML. They received 2 to 7 injections, and the total dose was 45 mg to 280 mg. There were tolerable local pain upon injections in all patients, local redness and swelling in one patient, fever in two patients, mild gastrointestinal reactions in one patient, fatigue in one patient, and palpitation and discomfort in one patient. After close observation or corresponding symptomatic treatment, the symptoms subsided. No special treatment was given. The follow-up time was 9 to 30 months, and the median was 20 months. The lymphomas in all patients were controlled without recurrence. The MRI showed that local lesions disappeared completely in five patients, and the conjunctiva and the extraocular muscle became thickened in three patients. There was no abnormity in complete blood count, serum β2 microglobulin and lactate dehydrogenase. Conclusion: The intralesional rituximab administration is a simple, effective therapy for localized POAML with no systemic invasion. (Chin J Ophthalmol, 2020, 56: 839-845).
目的： 观察利妥昔单克隆抗体（单抗）局部应用对原发性眼附属器黏膜相关淋巴组织型（MALT）淋巴瘤的治疗效果。 方法： 回顾性系列病例研究。收集2017年9月至2018年12月于郑州大学第一附属医院眼科诊治并接受局部注射利妥昔单抗治疗的8例原发性眼附属器MALT淋巴瘤患者的临床及随访资料。患者中男性3例，女性5例，年龄35～83岁，年龄中位数为58岁。所有患者均接受病变大部分切除手术，组织病理学确诊为MALT淋巴瘤，且免疫组织化学染色均提示CD20+；经胸腹部CT、骨髓活检或正电子发射断层显像-CT等检查排除全身其他病灶。局部注射利妥昔单抗治疗：结膜型患者行结膜下浸润注射；泪腺型和眼眶型患者通过眼球周围间隙行眼眶内多点注射。记录利妥昔单抗治疗剂量、药物起效时间、肿瘤消退情况；局部疼痛、肿胀等局部反应情况；发热、胃肠道反应、全血细胞计数等全身反应指标及血清β2微球蛋白和乳酸脱氢酶等淋巴瘤全身复发指标结果。 结果： 8例患者中结膜型患者2例（其中双眼病变1例），泪腺型患者1例，眼眶型患者5例。利妥昔单抗局部注射治疗次数2～7次，总剂量为45～280 mg。局部疼痛8例、局部红肿1例、发热2例、轻度胃肠道反应1例、乏力1例、心慌不适1例。所有患者经严密观察或相应对症处理后，症状自行消退，均未给特殊处理。随访9～30个月，中位数为20个月，8例患者病变全部控制，均未见复发；MRI检查显示局部病变完全消失5例，遗留局部结膜和眼外肌增厚3例；全血细胞计数、血清β2微球蛋白和乳酸脱氢酶均未见异常。 结论： 利妥昔单抗局部注射可用于治疗全身无侵犯的局限性原发性眼附属器MALT淋巴瘤，是一种简便、有效的治疗方式。（中华眼科杂志，2020，56：839-845）.
Keywords: Eye neoplasms; Injections, intralesional; Lymphoma, B-cell, marginal zone; Rituximab.