Choroidal metastasis is the most common form of intraocular malignancies. It may occur in up to 10% of patients with systemic metastasis with almost half of the patients developing central nervous system disease. The most common primary sites of ocular metastasis are breast cancer in women and lung cancer in men. In most cases, these lesions tend to be small and asymptomatic and are not evaluated by an ophthalmologist. For symptomatic and larger lesions, external beam radiation offers an excellent alternative to save the eye and stabilize vision. Bevacizumab (Avastin), humanized monoclonal anti-body against vascular endothelial growth factor (VEGF) has shown promising results when used in the treatment of choroidal metastasis. [1]

Systemic or intravitreal injection of bevacizumab has resulted in complete and durable remission of choroidal metastasis from non-small cell lung cancer, colorectal cancer, breast cancer and kidney carcinoma. [2-6] However, Alasil T et al have reported a case of choroidal metastasis from renal cell carcinoma of clear cell type in a patient of 65 year old who had undergone radical nephrectomy 15 years back. Choroidal metastasis in this patient was non-responsive to intravitreal injection of bevacizumab. [7] Inherent resistance of clear cell type of renal cell carcinoma may be reason for this non-responsiveness to intracameral bevacizumab. [8]

Symptomatic choroidal metastasis from common tumor sites and histologies are effectively treated with systemic or intravitreal bevacizumab. Nevertheless, we should closely monitor for response in the symptomatic patients with choroidal metastasis especially from the tumors of less common and resistant histopathology.

1. Giuliari GP, Sadaka A. Uveal metastatic disease: current and new treatment options (review). Oncol Rep. 2012 Mar;27(3):603-7.
2. George B, Wirostko WJ, Connor TB, Choong NW. Complete and durable response of choroid metastasis from non-small cell lung cancer with systemic bevacizumab and chemotherapy. J Thorac Oncol. 2009 May;4(5):661-2.
3. D'Antonio C, Viterbo A, Romiti A, Enrici MM, Lauro S, Marchetti P. Complete regression of a non-small cell lung cancer choroidal metastasis with intravitreal bevacizumab. J Thorac Oncol. 2012 Feb;7(2):468-9.
4. Cézé N, Lecomte T, Watier H. Tumour angiogenesis inhibition by therapeutic monoclonal antibodies. Med Sci (Paris). 2009 Dec;25(12):1099-104.
5. Yao HY, Horng CT, Chen JT, Tsai ML. Regression of choroidal metastasis secondary to breast carcinoma with adjuvant intravitreal injection of bevacizumab. Acta Ophthalmol. 2010 Nov;88(7):e282-3.
6. Lin CJ, Li KH, Hwang JF, Chen SN. The effect of intravitreal bevacizumab treatment on choroidal metastasis of colon adenocarcinoma--case report. Eye (Lond). 2010 Jun;24(6):1102-3.
7. Alasil T, Khazai B, Loredo L, Rauser ME. Renal cell carcinoma metastasis to the ciliary body responds to proton beam radiotherapy: a case report. J Med Case Rep. 2011 Aug 3;5:345.
8. Pathology of Clear Cell Renal Cell Carcinoma: Cytokine immunotherapy [article online], 2011. Medscape Reference – Drugs, diseases and procedures. New York, NY. Available from http://emedicine.medscape.com/article/1612043-overview#aw2aab6c14. Accessed on 17 June 2012.

Competing interests: None declared