This is a 54-year old female with longstanding metastatic breast cancer was referred for management of choroidal metastases. She was first treated with external beam radiotherapy and experienced some response before later suffering the progression of her eye disease. We then treated her using full fluence Photodynamic therapy (PDT) with Verteporfin, which resulted in a regression of her lesions until she passed away due to other illnesses. This is the first documented successful application of PDT for choroidal metastasis from a primary breast cancer refractory to external beam radiotherapy.
A 54-year-old female with a history of metastatic breast carcinoma presented with left-sided photopsias and decreased vision. Her breast cancer had previously been treated with lumpectomy without adjuvant radiotherapy to the breast, and she was taking Anastrozole for maintenance at the time of presentation.
Visual acuity was 20/20 in both eyes. Intraocular pressure by Tonometry was 25 mm Hg in the left eye and 24 mm Hg in the right eye. The slit-lamp examination of the external eye and anterior segment were normal in both eyes. Fundoscopic visualization and photography of the peripheral left eye showed 3 poorly defined amelanotic subretinal lesions. Fluorescein angiography of the left eye showed mild hyperfluorescent, and optical coherence tomography (OCT) demonstrated multiple subretinal masses. The examination of the right eye was unremarkable. Choroidal metastasis of the left eye was diagnosed and the patient received whole-eye external beam radiotherapy delivered in multiple fractions to a total dose of 35 Gy. One month after the last fraction, repeat examination demonstrated the stability of the lesions without obvious growth. Two months following treatment however, all left eye choroidal metastases demonstrated growth. The patient was treated with full fluence Photodynamic therapy using a Verteporfin photosensitizer to all lesions in a single setting. One month following PDT (4.5 months after presentation), all metastases had regressed with the stability of visual acuity and symptom improvement. The patient expired three months following her last follow up due to progressive thoracic and intracranial metastases.