Intravitreal bevacizumab as an adjuvant treatment of choroidal metastasis

Purpose Metastatic tumours are the most common intraocular malignancy. Although rare, lung and breast cancers are two of the predominant tumours to metastasize to the eye. The choroid, an highly vascularised structure, is the intraocular site most commonly affected. Recent case reports point intravitreal bevacizumab as an option in the treatment of these tumours. The authors present a case of choroidal metastasis secondary to breast carcinoma treated with intravitreal bevacizumab. Methods A patient with choroidal metastasis was treated with intravitreal bevacizumab. Clinical and tumour response was observed and documented for a period of 24 months. Results A 55‐year‐old female patient, with an history of localized breast carcinoma treated nine years previously, presented with decreased visual acuity in the right eye. She had a best corrected visual acuity (BCVA) of counting fingers at 10 centimetres. Examination revealed a choroidal metastatis in the temporal region of the posterior pole as well as serous macular detachment. The off‐label treatment with intravitreal bevacizumab was proposed and the patient underwent three consecutive (one month interval) intravitreal injections, as an adjuvant to the chemotherapy with paclitaxel. With just one IVB, the patient reported an improvement of her visual acuity and one month after the third IVB she had a BCVA of 6/10. At this time, significant tumour and subretinal fluid regression was confirmed by fundus examination and optical coherence tomography. Until the present time (two years follow‐up). the patient remained clinically stable with no need of further IVB. There were no ocular or systemic complications with the treatment instituted. Conclusions The combination of intravitreal bevacizumab and systemic chemotherapy seems to be effective and safe for management of choroidal metastasis from breast carcinoma.