New concepts in the diagnosis and management of choroidal metastases

Publication date: Available online 19 September 2018Source: Progress in Retinal and Eye ResearchAuthor(s): Thibaud Mathis, Pauline Jardel, Olivier Loria, Benoit Delaunay, Anh-minh Nguyen, Francesco Lanza, Carlo Mosci, Jean-Pierre Caujolle, Laurent Kodjikian, Juliette ThariatAbstractThe most frequent site of ocular metastasis is the choroid. The occurrence of choroidal metastases has increased steadily due to the longer survival of metastatic patients and the improvement of diagnostic tools. Fundoscopy, ultrasonography, and fluorescein angiography are now complemented by indocyanine green angiography and optical coherence tomography. Choroidal tumor biopsy may also confirm the metastatic nature of the tumor and help to determine the site of the primary malignancy.There is currently no consensus on the treatment strategy. Most patients have a limited life expectancy and for these complex treatments are generally not recommended. However, recent advances in systemic therapy have significantly improved survival of certain patients who may benefit from an aggressive ocular approach that could preserve vision. Although external beam radiation therapy is the most widely used treatment, more advanced forms of radiotherapy that are associated with fewer side effects can be proposed in select cases.In patients with a shorter life expectancy, systemic therapies such as those targeting oncogenic drivers, or immunotherapy can induce a regression of the choroidal metastases, and may be suf...
Source: Progress in Retinal and Eye Research - Category: Opthalmology Source Type: research