Triple Therapy with Rituximab, IVIg and Intravitreal Corticosteroids for Melanoma-associated Retinopathy (MAR): TTRIIC does the trick.

PURPOSE Melanoma-associated retinopathy (MAR) responds poorly to currently-available therapies, with continued chronic decline in visual function being the norm, despite treatment. The purpose of this report is to describe the excellent response of a patient with MAR to a triple therapy regimen of rituximab, intravenous immunoglobulin (IVIg), and intravitreal corticosteroids. METHODS Single interventional case report describing management of melanoma-associated retinopathy and the patient's response to this treatment. Retinal function was monitored by serial visual acuity, fundus exams, Goldmann visual fields, and electroretinography. RESULTS A 65-year old man presented with new onset photopsia, decrease visual acuity and nyctalopia in both eyes in the setting of recently-diagnosed stage IIIB melanoma, initially treated with wide local excision and adjuvant interferon. He was diagnosed with melanoma-associated retinopathy that initially worsened during his course of interferon for treatment of the melanoma. We initiated triple therapy of rituximab, IVIg and intravitreal corticosteroids, and this resulted in full return of electroretinography function and resumption of 20/20 visual acuity OU. CONCLUSION This is the first reported case of the utility of triple therapy with rituximab, IVIg, and intravitreal steroids for successful management of melanoma-associated retinopathy as demonstrated by improvement in acuity, symptoms, visual fields, and ERGs.