Rituximab in Refractory Non-Infectious Uveitis, Scleritis, and Idiopathic Orbital Inflammatory Syndrome: A Real-World Single-Centre Retrospective Case Series from Türkiye.

Abstract

Purpose: To describe outcomes and safety of rituximab (RTX) in refractory non-infectious uveitis, scleritis, and idiopathic orbital inflammatory syndrome (IOIS).

Methods: Single-centre retrospective series of eleven consecutive patients (21 eyes; one unilateral) treated with intravenous RTX (1,000 mg twice, 14 days apart, then six-monthly maintenance) between January 2023 and May 2026. Response was graded by at least two of three uveitis specialists.

Results: Mean follow-up was 19.0 months (3.9 cycles). Diagnoses were granulomatosis with polyangiitis (GPA; n = 3, PR3-ANCA positive), Vogt-Koyanagi-Harada disease (n = 2), demyelinating disease-associated uveitis (n = 2), and one each of IOIS, presumed juvenile sarcoidosis, lupus, and rheumatoid arthritis. Visual acuity was unchanged (logMAR 0.51 to 0.42; p = 0.272). Mean daily prednisolone-equivalent dose fell from 28.0 to 3.5 mg (87.7% relative reduction; p = 0.002). Modified McCluskey scores fell from 14.25 to 1.50 (n = 4); PR3-ANCA titres declined in all three GPA patients. Ten of eleven patients (90.9%) responded (five complete, five partial), including nine of ten (90.0%) with active ocular inflammation at initiation. The non-responder had sclerosing orbital disease. One herpes zoster reactivation occurred.      .

Conclusions: In this small, heterogeneous cohort, RTX was associated with marked corticosteroid sparing and favourable responses in all three subtypes. Both demyelinating cases responded, a two-patient observation relevant where anti-TNF is contraindicated. Absent visual gain likely reflects pre-existing damage. Because most patients continued an antimetabolite with corticosteroid premedication, the independent effect of RTX cannot be isolated.