Uveal metastases from carcinoid tumors: Clinical and therapeutic assessment

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Abstract

Purpose

To define the specific clinical characteristics of uveal metastases from carcinoids and the minimal invasive therapeutic approach.

Methods

Four consecutive cases of symptomatic uveal metastases from carcinoid tumors were included in this prospective analysis. Each patient underwent full ophthalmological examination, including A-B scan ultrasonography (US), fluorescein (FA) and indocyanine green angiography (IGA), and optical coherence tomography (OCT) at baseline and during follow-up. Follow-up examination was performed at 1 month and every 3 months thereafter.

Results

Mean follow-up was 17±6 months. Tree patients were affected by choroidal metastases (75%) whereas one patients by iris metastasis (25%). Choroidal metastases were ipo-pigmented, mainly located at the posterior pole and characterized by medium internal reflectivity at US, prominent vascular net at ICG and perilesional serous retinal detachment at OCT. Each patient was treated by photodynamic therapy (PDT) with verteporfine as sole focal treatment. Mean PDT sessions were 1.6 (1-3 sessions). Two patients (50%) showed clinical regression of the treated lesions, whereas in the others two patients (50%) tumor size remained stable during follow-up. Subretinal fluid resolved in all choroidal lesions. BCVA increased in three patients (75%) and remained unchanged in one patient (25%).

Conclusion

Uveal metastases from carcinoids are characteristically ipo-pigmented and highly vascularized. Photodynamic therapy appears to be an effective, safe and well-tolerated treatment option for the management these metastases.

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