Intravitreal bevacizumab for choroidal metastases secondary to adenocarcinoma of the lung

Abstract

To present a case of choroidal metastases from lung adenocarcinoma treated with intravitreal bevacizumab prior to external beam radiotherapy and systemic chemotherapy. Retrospective interventional. A 72-year-old male, with no significant past ocular or medical history, presented with decreased visual acuity (VA) and a relative scotoma in his left eye. Clinical examination revealed an elevated subretinal lesion in the superotemporal macula in the left eye with fovea-involving subretinal fluid (SRF). Systemic workup revealed metastatic primary adenocarcinoma of the lung. The patient was treated with two intravitreal bevacizumab injections 5 days apart. However, given persistent SRF, external beam radiation and systemic chemotherapy were initiated, which yielded a resolution of SRF, involution of the lesions, and restoration of VA. Although anti-vascular endothelial growth factor (anti-VEGF) therapy represents a therapeutic option for choroidal metastases, enthusiasm for positive results should be tempered. Anti-VEGF agents may be used as adjuncts with other modalities such as external radiotherapy and systemic chemotherapy in the management of such lesions.