Indocyanine Green Mediated Photothrombosis and High Dose Intravitreal Bevacizumab as Adjuvant Therapy for Isolated Choroidal Metastasis from Breast Cancer
A 47-year-old female patient was referred with a history of radical mastectomy for breast cancer 7 years earlier. She had been treated with radiotherapy and chemotherapy without evidence of systemic metastasis. She presented with progressive decrease in visual acuity in her right eye (OD) for 4 days. Visual acuity was counting fingers OD and 20/25 in the left eye (OS). Intraocular pressure (IOP) was 11 mmHg in both eyes. Anterior segment examination was unremarkable except for the presence of small clumps of pigment deposits on the right corneal endothelium and posterior polymorphous corneal dystrophy in the left eye. Fundus examination revealed an inferior juxtafoveal dome-shaped creamy choroidal tumor associated with perifoveolar serous retinal detachment and retinal pigment epithelium (RPE) clumps of brown pigment on the surface of the tumor; FA demonstrated a filling delay of choroidal vessels with ERD corroborated by B- and A-scan ultrasound evaluation which also showed a choroidal mass with moderate irregular internal reflectivity (A, B and C). Optical coherence tomography revealed highly reflective dots within the neurosensory retina, subretinal fluid and separation of retinal layers (D and E). Systemic chemotherapy was started but the patient remained unresponsive to treatment. Six months after initiation of systemic chemotherapy, IMP combined with multi-spot laser applications () and high dose IVB (4 mg/0.16 ml) were administered; laser light was applied for 100 seconds in each overlapping spot of 8.09 mm, and high dose IVB was injected immediately afterwards. Three weeks later, significant improvement of VA (20/400) and complete resolution of ERD was observed (A and B), meanwhile OCT showed no subretinal fluid (C). Four months after combined therapy, visual acuity further improved to 20/100.