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M. Mauget–Faysse, M. Quaranta–El Maftouhi, J. Gambrelle; Photodynamic Therapy in the Treatment of Choroidal Metastasis From a Lung Adenocarcinoma . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4710.
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To report the use of photodynamic therapy (PDT) to treat a patient with choroidal metastasis from a lung adenocarcinoma
The patient was evaluated with visual acuity testing, fundus color photographs, biomicroscopy, and OCT every 6 weeks; fluorescein and ICG angiography, every 3 months; and B–scan ultrasonography every 6 months. Follow–up lasted 8 months. PDT consisted of intravenous Verteporfin (6 mg/m2) infusion over 4 minutes and, after another 5 minutes, application of a 689 nm diode laser with a spot size of the greatest linear dimension of the lesion (7.4 mm diameter) over 166 seconds.
The patient had a lung adenocarcinoma with multiple metastases including one in the right choroid. He had just finished a course of ineffective chemotherapy lasting 18 months. Visual acuity at baseline was 20/70. Fundus examination showed a nerve fibre layer haemorrhage with venous stasis, and an amelanotic mass, 7.4 x 6.2 mm in size and 3 mm in height, surrounded by tiny exudates and associated with an exudative retinal detachment. On B–scan ultrasonography, the tumour had irregular internal reflectivity. Fluorescein and indocyanine green angiograms demonstrated tumor vascularity. OCT showed the tumor mass and the presence of a shallow retinal detachment. PDT was chosen as the primary treatment because of the higher risk of radiation–induced retinopathy and also because this tumour was well–demarcated, moderately thick, vascularised, and located close to the fovea. Soon after PDT and in the 8 months post–treatment, VA had improved to 20/30 without metamorphopsia. Fundus examination, B–scan ultrasonography and OCT demonstrated flattening of the tumour, disappearance of exudates and complete resolution of the retinal detachment. .
Although PDT cannot be considered as a standard treatment for choroidal metastasis, it appears to be a useful palliative procedure to ensure rapid vision improvement in patients with choroidal metastasis in whom survival is already compromised. This report also highlights the usefulness of OCT in the diagnosis and therapeutic follow–up of choroidal metastasis.
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