Abstract
Purpose :
Choroidal metastasis remains the most common type of ocular malignancy, affecting quality of life of patients who already carry poor prognosis from their primary cancers. Among the local treatment modalities for choroidal metastasis, photodynamic therapy (PDT) is an effective option and requires little time commitment. This study is a systematic review and meta-analysis aiming to investigate the efficacy and safety of photodynamic therapy in the treatment of choroidal metastasis.
Methods :
We compiled all cases of choroidal metastases treated with PDT in literature, and included the unreported cases seen at our institution, a tertiary referral center, for a comprehensive meta-analysis.
Results :
50 tumors in 40 eyes of 34 patients were identified from the choroidal metastases treated with PDT at our institution and from 12 case reports in literature since 2004. Tumors became significantly flatter after an average of 1.4 PDT treatments (mean thickness was 1.9mm pre-operatively vs 1.0mm post-operatively, p < 0.0001). Similarly, there was a significant decrease in central macular thickness (CMT) post-operatively (mean CMT of 289µm vs 454µm, p = 0.03). After PDT, the majority of tumors completely flattened, had reduced thickness or stayed flat (82% of the tumors) and no longer had sub-retinal fluid (75% of the eyes). PDT also resulted in visual protection (stable or improved vision) in 77.5% of treated eyes, but there was no significant difference in vision between pre-PDT and post-PDT eyes (P = 0.54). There were no adverse events reported, and PDT was shown to be safe and effective in treating fovea and optic nerve involving tumors (tumor control efficacy of 86% and 75%, respectively), as well as metastases originating from the most common primary sites (tumor control efficacy of 94% in lung adenocarcinoma and 92% in breast carcinoma).
Conclusions :
Although PDT requires less time consumption than other local treatment methods for choroidal metastasis, it showed effective tumor control and vision protection in our meta-analysis.
This is a 2021 ARVO Annual Meeting abstract.