OCT : Noninvasive method to monitor effectivity of chemotherapy in lung carcinoma.

DR PRAJAKTA PATIL(Fellow)DR SARVESH TIWARI(Consultant)

DR GAURAV SHAH(Honorary Consultant)DR ANAND SUBRAMANYAM(Head of the Department)

K B H Bachooali Ophthalmic and ENT Hospital,Parel,Mumbai

PURPOSE

• To evaluate the role of OCT in a patient with choroidal metastasis who has been treated with chemotherapy and external beam radiotherapy

MATERIALS AND METHODS

• 63 years old male

• k/c/o primary adenocarcinoma of lung

• On chemotherapy (3 cycles completed) and EBRT ( 1 session completed)

• c/o DOV (OD) since 3 months

• BCVA (OD) CF ½ meter, (OS) 6/6

(OD)Multiple elevated cream- yellow coloured mass lesions involving choroid in superotemporal quadrant

(1) Neurosensory RD (2) Highly reflective lesions overlying

the RPE–choriocapillaris complex,subretinal space ,along inferior margin of retina.

After 4 cycles of chemotherapy(OD) BCVA CF 1 meter

Size and height of choroidal lesions decreased

Subretinal fluid decreasedHyper reflective lesions in subretinal Space, overlying RPE choriocapillay complex persisting

After 4 cycles of chemotherapy and 3 cycles of maintenance therapy

(OD) BCVA 6/24

Choroidal lesions flattened

Macular contour regained withdisappearence of hyper reflective lesions

Discussion

• Choroidal metastasis is the most frequent ocular tumor.1,2

• The most frequent primary tumors in

choroidal metastases are located in the lung and the mammary glands 3

(1)Duke JR, Walsh FB. Metastatic carcinoma to the retina. Am J Ophthalmol 1959;47:44 – 8. 4.

(2) Koenig RP, Johnson DL, Monahan RH. Bronchogenic carcinoma with metastases to the retina. Am J Ophthalmol 1963; 56:827–9

(3) Barak A, Neudorfer M, Heilweil G, Merimsky O, Lowenstein A, Inbar M, et al. Decreased prevalence of asymptomatic choroidal metastasis in disseminated breast and lung cancer: argument against screening. Br J Ophthalmol 2007; 91: 74-75

• Metastatic cancer to the uvea and optic disc involves the posterior pole in 40% of cases.

Shields JA, Shields CL. Intraocular Tumors: A Text and Atlas. Philadelphia: WB Saunders; 1992:207–38

Our patient had following OCT features :(1) Neurosensory RD (2) Highly reflective lesions overlying the RPE–

choriocapillaris complex (3) Highly reflective points in the subretinal

space

Arevalo, J.F., Fernandez, C.F., and Garcia, R.A. Optical coherence tomography characteristics of choroidal metastasis. Ophthalmology. 2005; 112: 1612–1619

After chemotherapy, OCT of our case showed improvement of the serous RD and reduction ofthe lesion’s size, with recovery of the normal retinal architecture

Conclusion

• OCT is a useful imaging technique to study choroidal metastatic tumors.

• Optical coherence tomography in patients with choroidal metastasis demonstrates the secondary retina–RPE changes

• OCT can be used as noninvasive method to monitor the effectivity of chemotherapy in choroidal metastasis involving posterior pole