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

Purpose: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.Methods: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.Results: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).Conclusion: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.