Uveal metastatic disease: Current and new treatment options (Review)

Abstract

Abstract. Choroidal metastasis represents the most common form of intraocular malignancies. It may occur in up to 10% of patients with systemic metastasis with almost half of the patients developing central nervous system disease. The most common primary sites of ocular metastasis are breast cancer in women and lung cancer in men. In most cases, these lesions tend to be asymptomatic and are not evaluated by an ophthalmologist. The diagnosis is generally made by the history of present or prior malignancies and an ophthalmological examination with slit-lamp biomicroscopy and indirect ophthalmoscopy. As with other malignancies, management may vary with each patient. Small tumors, that do not compromise the vision and that have responded previously to systemic treatment, may be closely observed. For larger lesions and for symptomatic ones, external beam radiation offers an excellent alternative to save the eye and stabilize vision. Bevacizumab (Avastin), a potent monoclonal antibody that has also been employed for the treatment of ocular vaso-proliferative diseases, has been used in the treatment of choroidal metastasis and has shown promising results.

Intravitreal bevacizumab for consecutive multiple choroidal breast metastatic lesions

“…Therapeutic modalities for choroidal metastasis include enucleation, external beam radiotherapy, laser photocoagulation, brachytherapy, chemotherapy and tamoxifen 1–4. Bevacizumab is a full-length recombinant humanised antibody against all isoforms of vascular endothelial growth factor A (VEGF-A), and has been approved by the FDA for intravenous use in metastatic carcinoma of the colon or rectum and for non-small cell lung cancer.…”

Case Report: Scleral Metastasis of Esophageal Squamous Cell Carcinoma

“…The treatment of ocular metastases includes radiotherapy, chemotherapy, laser surgery, anti-vascular endothelial growth factor administration and finally eye enucleation. Enucleation is not recommended in the early stages and should be considered as a last resort [12]. Regardless of the type of primary tumor, survival of patients with a metastatic ocular lesion is very weak.…”

Choroidal and Cutaneous Metastasis from Urothelial Carcinoma of the Bladder after Radical Cystectomy: A Case Report and Literature Review

“…In contrast, choroidal or cutaneous metastasis is extremely rare. The occurrence of choroidal metastasis from all forms of carcinomas ranges from 2.3% to 9.2%, with the most common primary sites being the breasts and lungs [9]. However, since the first case reported in 1974 [4], there have been only 5 additional cases of metastasis to the choroid from urothelial carcinoma of the bladder prior to the present case [5–7].…”

“…Due to difficulty with pathological diagnosis, these tumors are identified by history of present or prior malignancies and results of an ophthalmological examination with slit-lamp biomicroscopy and indirect ophthalmoscopy [9]. In addition, optical coherence tomographic and ocular ultrasound and MRI examinations may aid in the diagnosis of choroidal metastasis.…”