PHOTODYNAMIC THERAPY FOR THE TREATMENT OF CHOROIDAL METASTASES: A Case Series and Meta-analysis
Minh T Nguyen1, Andrew W Stacey
1Department of Ophthalmology, University of Washington, Seattle, Washington.
Purpose:
To investigate the efficacy and safety of photodynamic therapy (PDT) in the treatment of choroidal metastasis.
Methods:
We conducted a systematic review of all reported cases of choroidal metastases treated with PDT in literature, and included the cases from our institution, for a comprehensive meta-analysis.
Results:
We identified 52 tumors in 40 eyes of 34 patients. The mean age was 60 years (range 28-77). The mean tumor thickness was 1.9 mm (range 0-4.8 mm), whereas the mean largest basal diameter was 8.2 mm (range 1.5-30 mm) on presentation. After an average of 1.4 treatment visit, PDT resulted in decreased tumor thickness (mean 1.9 mm before vs. 1.0 mm after PDT, P < 0.0001) and decreased central macular thickness (mean 454 µm before vs. 289 µm after PDT, P = 0.03). After PDT, 82% of tumors had reduced thickness, and subretinal fluid resolved in 75% of eyes. Photodynamic therapy also resulted in stable or improved vision in 78% of treated eyes (logMAR 0.50 before vs. 0.56 after PDT, P = 0.54). No adverse events were reported, and PDT was effective in treating the most common choroidal metastases (tumor control rate of 94% in 16 lung adenocarcinoma and 92% in 26 breast carcinoma metastasis cases).
Conclusion:
Photodynamic therapy is effective at controlling tumors and preserving vision in patients with some choroidal metastases. Because of its minimal time commitment and good safety profile, PDT should be considered as a potential first-line treatment for small choroidal metastases.
