The effect of intravitreal bevacizumab and transpupillary thermotherapy on choroidal metastases and literature review

Abstract

Aims: To represent the effects of transpupillary thermotherapy (TTT) and intravitreal bevacizumab on choroidal metastases and review the literature.

Settings and design: A retrospective, interventional, noncomparative case series.

Materials and methods: A retrospective, interventional, noncomparative case series of five eyes in three patients with choroidal metastases was conducted. Fundus findings of choroidal metastases were divided into two types: Solitary or diffuse type. The size of the tumor was termed small (<10 mm diameter), medium (10-15 mm diameter) or large (>15 mm diameter). All eyes received one session of TTT followed by 3 weekly intravitreal bevacizumab injections as an adjuvant therapy. The parameters of treatment for TTT were 1.2-3 mm spot size, 150-300 mW, 60 s with the whole lesion covered confluently. The changes in preoperative and postoperative best-corrected visual acuity (BCVA) were recorded. Serial color fundus photography and optical coherent tomography were performed to measure the treatment efficacy.

Results: All eight choroidal metastases were solitary type. The size of six tumors was small, the size of one tumor was medium, and the size of one tumor was large. All five eyes of the three patients had improvement of BCVA after treatment. Fundus photos revealed tumor shrinkage and the mean shrinkage percentage was 61.27 ± 21.71%. Optical coherence tomography revealed complete resolution of serous retinal detachment. There was no recurrence after 6 months follow-up.

Conclusions: TTT combined with intravitreal bevacizumab injections brought about beneficial effects in reducing tumor size and improving vision in all five eyes of the three patients. Despite the retrospective nature of our study, the absence of control group and the size limitation that, of course, limit the statistical power, TTT combined with intravitreal bevacizumab seems to be efficient in providing another cost-reducing and time-saving treatment option for patients with choroidal metastases. The antineoplastic properties of bevacizumab make it a viable adjunctive therapy. Studies with more cases and a longer follow-up period are warranted.

Figure 1

1(a) A mass (tumor I) OD; 1(b) The mass subsided. 2(a) One large mass over nasal quadrant (tumor II) and one small mass (tumor III) above the temporal-superior arch OS; 2(b) The masses subsided. 3(a) One tumor in the temporal quadrant (tumor IV) and the other with exudative RD (tumor V) in the upper posterior pole extending beneath the macula OD; (b) The tumors shrank. 4(a) Two masses in the nasal (tumor VI) and inferior (tumor VII) quadrants OS; 4(b) The tumors shrank. 5(a) A mass with exudative RD (tumor VIII) in the superior-temporal quadrant involving macula OS; 5(b) The mass shrank

Figure 2

1(a) The optical coherent tomography (OCT) showed marked subretinal fluid and the central foveal thickness (CFT) was 773 μm OD; 1(b) The OCT showed the resolution of exudative retinal detachment and the CFT reduced to 252 μm OD. 2(a) The OCT showed massive subretinal fluid and the CFT was 983 μm OD; 2(b) The OCT demonstrated no exudative retinal detachment and the CFT reduced to 224 μm OD. 3(a) The OCT revealed an area of choroidal elevation with overlying subretinal fluid and the CFT was 413 μm OS; 3(b) The OCT showed the resolution of choroidal elevation and subretinal fluid OS. The CFT reduced to 235 μm