A 61-year-old woman presented with severe blepharitis and meibitis in both eyes since 2008 and who had received a filariasis in her left eye.
History of chronic gastritis and episodes of nephritic colic.
In 2012, the conjunctiva showed a high benign lesion consistent with lymphoid hyperplasia in the right eye.
The biopsy confirmed a low grade B lymphoproliferative process, MALT type, with bilateral conjunctival involvement in stage IE.
Immunohistochemistry was positive for CD20 and Bcl 2 and negative for CD3, CD5, CD23, Bcl 6 and CD10.
Lymphoma was ruled out with aspiration and bone marrow biopsy.
Helicobacter pylori was also detected, and a triple treatment with erradication (amoxicillin, clarithromycin and clarithromycin).
Serology ruled out other infectious agents.
She started systemic therapy with rituximab weekly, at a dose of 375 mg/m2.
At the same time, it was considered to continue treating this condition, as previously received for blepharitis, at a dose of 100 mg per day.
After 4 weeks of intravenous therapy recurrence of lymphoproliferative process was observed.
In cases reported by Savino et al and Ferreri et al, intralesional rituximab was administered at a concentration of 6 mg/ml in OA.
Each dose was prepared for immediate use in the Service following good practices for preparing ophthalmic preparations.
The starting point was 1.8 ml of rituximab (10 mg/ml) and 1.2 ml of 2% lidocaine crossing the mixture, with a 0.22 μm filter, into a syringe ready to apply in the operating room.
The protocol consisted of weekly administration for 4 weeks followed by monthly administration for 6 months.
Subconjunctival injections were 0.6 to 0.7 ml (3.6 mg to 4.2 mg of rituximab), placing approximately 0.2 ml in 1/3 internal, 1/3 middle and 1/3 external in each bag bottom in BE.
After each injection, the use of tobramycin eye drops and dexamethasone eye drops was recommended (such as antibiotic prophylaxis and antidiabetic injections, respectively) every 12 hours.
Autologous serum eye drops were also prescribed every 6 hours to prevent dry eye and possible improvement in response to treatment.
After the second administration, a 10% acetylcysteine eye drop was prescribed, indicated for filamentosa and dry eye.
After the second administration, there was a decrease in lymphoid tissue in BE and after the eighth administration only one lymphoid tissue plaque was observed in the outer third of the fundus of RE and no lesions were observed in LE.
One month after the end of the treatment cycle, no lymphoma-compatible lesions were seen, although blepharitis was still present.
As an adverse effect, the patient reported discomfort from dry eye.
