Intravitreal bevacizumab for consecutive multiple choroidal breast metastatic lesions

A 49-year-old woman presented with visual loss in the right from optic nerve metastatic disease and asymptomatic choroidal lesion at the inferior arcade. Throughout 22 months of follow-up, she developed a total of five different sequential choroidal metastases to the left eye that were non-responsive to chemotherapy but showed prompt tumour regression by fundus examination and fluorescein angiography within 2 weeks after a single intravitreal bevacizumab. The control of the lesion with a single intravitreal injection of bevacizumab reflects the superior choroidal bioavailability of the drug. The persistence of subretinal fluid at the site of prior metastases may be thought to be one sign of persistence of malignant cells, but in the current case and in the literature, it seems a reflection of a diseased retinal pigment epithelium with probable damage from the tumour invasion.