Effective Treatment with Intravitreal Injection of Bevacizumab for Exudative Retinal Detachment Secondary to Choroidal Metastasis of Non-Small Cell Lung Carcinoma
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Unexpected drug reaction
Hirotoshi Yasui, Kazuhide Sato, Yoshihiro Takeyama, Hiroaki Nishihara, Matsuyoshi Maeda, Hideo Gonda, Ryujiro Suzuki
(Department of Respiratory Medicine, Toyohashi Municipal Hospital, Toyohashi-shi, Japan)
Am J Case Rep 2015; 16:728-732
Visual disturbance caused by cancer metastasis from other organs is one of the largest challenges to cancer patients’ quality of life (QOL). Lung cancer is the most frequent primary site of choroidal metastasis in men, but improvement of visual disturbance has not always been emphasized in lung cancers. Recently intravitreal bevacizumab is a newer modality being tried for local control of choroidal metastases.
CASE REPORT: A 68-year-old man was admitted the hospital with complaint of visual disturbance in his left eye. He was diagnosed with lung adenocarcinoma cT2N0M1b (OSS, OTH) stage IV. The ophthalmologic evaluation showed exudative fluid, which caused retinal detachment under the retina. Fluorescence angiography showed granular hyperfluorescence with leakage consistent with a tumor. He received radiotherapy for bone metastasis and systematic chemotherapy with carboplatin, pemetrexed, and bevacizumab, as well as intravitreal injection of bevacizumab 1.25 mg to improve the visual disturbance. His visual symptom and retinal detachment improved until he died. An autopsy revealed that the metastatic lesion in his left eye was totally cured macroscopically and microscopically.
CONCLUSIONS: We report a case of exudative retinal detachment secondary to a metastatic choroidal tumor from lung adenocarcinoma, which was treated with chemotherapy and intravitreal injection of bevacizumab. Although he finally died of lung cancer, he maintained his visual QOL and autopsy revealed complete cure of the choroidal metastasis.
Keywords: Bevacizumab - administration & dosage, Aged, Angiogenesis Inhibitors - administration & dosage, Carcinoma, Non-Small-Cell Lung - secondary, Choroid Neoplasms - secondary, Fluorescein Angiography, Fundus Oculi, Humans, Intravitreal Injections, Lung Neoplasms - pathology, Male, Positron-Emission Tomography, Retinal Detachment - etiology, Tomography, X-Ray Computed