TREATMENT OF CHOROIDAL METASTASIS WITH COMBINED PHOTODYNAMIC THERAPY AND BEVACIZUMAB AND COMPARISON WITH PHOTODYNAMIC THERAPY ALONE.

Abstract

To evaluate the efficacy of the treatment of choroidal metastasis with combined photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) and compare it with PDT alone. Retrospective analysis of 41 choroidal metastatic tumors: 19 tumors (13 patients) treated with PDT + IVB versus 22 tumors (8 patients) treated with PDT alone between 2011 and 2023. Outcomes measured included best-corrected visual acuity, tumor dimensions, central macular thickness, and subretinal fluid at baseline, 6 weeks, and final follow-up. With median follow-up of 7 (range: 3-84) months, the PDT + IVB group showed significantly better outcomes than the PDT alone group: improved best-corrected visual acuity at 6 weeks and final visit ( P = 0.02), higher complete subretinal fluid resolution at 6 weeks (68% vs. 27%, P = 0.002), and significant decrease in tumor thickness at both timepoints ( P = 0.04 and P = 0.004). The PDT alone group showed no significant change in tumor thickness. Tumor control rates (defined by fluid resolution and decreased thickness) were superior in the PDT + IVB group at 6 weeks (73.3% vs. 26.6%, P = 0.009) and final visit (92% vs. 47%, P = 0.01). This first series using combined PDT + IVB for choroidal metastasis demonstrates superior early and long-term functional and anatomical outcomes compared with PDT alone, suggesting it as a more effective management approach.