Orelabrutinib in combination with pomalidomide for the successful treatment of primary vitreoretinal lymphoma: a case report

Primary vitreoretinal lymphoma (PVRL) is a rare intraocular malignancy often misdiagnosed as chronic uveitis, presenting significant diagnostic and therapeutic challenges. A 55-year-old male with one year of progressive bilateral vision loss was initially misdiagnosed with bilateral uveitis and treated unsuccessfully with corticosteroids. Diagnostic vitrectomy confirmed bilateral PVRL. The patient initially received intravitreal methotrexate injections but developed methotrexate-induced toxic keratitis and progressive cataract, requiring discontinuation of this therapy. He was subsequently transitioned to systemic treatment with anti-CD20 monoclonal antibody and oral pomalidomide and orelabrutinib, which achieved complete clearance of vitreous disease, normalization of aqueous IL-10, and sustained clinical remission without significant hematologic or cardiac toxicities. Precise diagnosis and individualized treatment regimens are essential for PVRL therapy, with the orelabrutinib-pomalidomide combination representing a promising, well-tolerated chemotherapy-free strategy.