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Treatment of ocular metastasis with anti-VEGF: A literature review and case report

      Abstract

      Purpose

      This is the first case report where 1.25 mg intravitreal bevacizumab (IVB) correlated with choroidal mass resolution from metastatic breast cancer given concurrently with chemotherapy demonstrating, at best, disease stability in other organs.

      Study design

      Case report.

      Methods

      Upon confirmation of choroidal, liver and bone metastasis from breast carcinoma, a 72-year-old female received four intravitreal bevacizumab 1.25 mg injections based on the presence of subretinal and intraretinal fluid. Visual outcomes were analyzed by ophthalmologic evaluation, B-scan, fluorescein angiography, and optical coherence tomography.

      Results

      After 3 treatments of 1.25 mg intravitreal bevacizumab, visual acuity improved from 20/125 OD to 20/30 OD. These results were maintained for 5 months, after which a 4th IVB injection was given to try to further improve visual outcomes. Following this, complete resolution of the mass was observed with remaining pigmentary changes and vision improved to 20/25 one month following this. IVB was administered concurrently to systemic chemotherapy that demonstrated at best disease stability in metastases in other organs.

      Conclusion

      In this case 1.25 mg intravitreal bevacizumab proved to be a safe, effective and relatively easy treatment for choroidal metastasis from breast cancer. An important benefit of intravitreal bevacizumab therapy for choroidal metastasis is the ease of administration and minimal time commitment required as compared to other therapies. Further studies should be conducted to confirm the appropriate dosing and long-term outcomes of intravitreal bevacizumab to treat choroidal metastasis.

      RÉSUMÉ

      Objet

      Ceci est le premier compte-rendu selon lequel le bevacizumab intravitréen (BIV) de 1,25 mg qui, en relation avec la résolution d’une masse choroïdienne métastatique d׳un cancer de sein simultanément avec la chimiothérapie, et démontrant, au mieux, la stabilité de la maladie dans d’autres organes.

      Nature

      Compte rendu.

      Méthodes

      Sur confirmation d’une métastase choroïdienne, du foie et des os, dus à un carcinome mammaire, une femme de 72 ans a reçu quatre injections intravitréennes de bevacizumab 1,25 mg, fondées sur la présence de fluide sous-rétinien et intrarétinien. Les résultats visuels ont été analysés par évaluation ophtalmologique, B-scan, angiographie à la fluorescéine et tomographie par cohérence optique.

      Résultats

      Après 3 traitements de 1,25 mg de bevacizumab intravitréen, l’acuité visuelle s’est améliorée, de 20/125 OD à 20/30 OD. Ces résultats ont été maintenus 5 mois, après quoi une 4e injection de BIV a été administrée pour améliorer davantage les résultats visuels. Par la suite, la résolution entière de la masse a été observée selon les changements pigmentaires restants et l’amélioration de la vision à 20/25 le mois suivant. Le BIV a été administré en même temps que la chimiothérapie systémique, qui avait démontré, au mieux, la stabilité de la maladie dans les métastases des autres organes.

      Conclusion

      Dans ce cas, 1,25 mg de bevacizumab intravitréen se sont avérés un traitement sécuritaire, efficace et relativement facile pour la métastase choroïdienne provenant du cancer du sein. Un avantage important de la thérapie du bevacizumab intravitréen pour la métastase choroïdienne est la facilité d’administration et le temps minime requis comparativement à d’autres thérapies. D’autres études devraient être effectuées pour confirmer la dose appropriée et les résultats à long terme du bevacizumab intravitréen pour traiter la métastase choroïdienne.
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