Autoimmune retinopathy (AIR) is an inflammatory condition in which the patient s own immune system is attacking his or her eyes and causing vision loss. Patients with AIR are generally treated with immunosuppressive agents to treat the eye inflammation; however, the standard treatment for this disease is still being developed. Rituximab, an immunosuppressive agent, is a monoclonal antibody that is directed against a part of the immune system that may be an important cause of AIR. Rituximab is approved for the treatment of non-Hodgkin s lymphoma and rheumatoid arthritis, but is not approved for the treatment of AIR.

Because of the presumed autoimmune nature of AIR, various forms of immunomodulatory approaches have been empirically  tried.

Antimetabolites such as mycophenolate mofetil, azathioprine and T-cell inhibitors such as cyclosporine have been used. Less frequently, targeted B-cell therapy, such as anti-CD20 monoclonal antibody (Rituximab), has also been used in the treatment of npAIR.Most evidence for Rituxan is based onc se reports and series. There are currently no clear parameters to guide treatment and no clear indicators for prognosis.

Clear Decision:

References:

Weleber RG, Watzke RC, Shults WT, Trzupek KM, Heckenlively JR, Egan RA, Adamus G. Clinical and electrophysiologic characterization of paraneoplastic and autoimmune retinopathies associated with antienolase antibodies. Am J Ophthalmol. 2005 May;139(5):780-94.

H Nida Sen Targeted B-cell Therapy with Rituximab for the Treatment of Autoimmune Retinopathy: Results of a Pilot Clinical Trial.  Invest Ophthalmol Vis Sci 2013;54: E-Abstract 5928.

Landon Grange, Monica Dalal, MD, and H. Nida Sen, MD, MHs. AIR Presents a True Diagnostic Challenge. Review of Opthalmology 6/5/2013 http://www.reviewofophthalmology.com/content/d/retinal_insider/c/41034/#sthash.h0JjhOf7.chM1IgOO.dpuf