Background: Recently, the development of new chemotherapy regimens and other factors have prolonged the survival of patients with cancer; however, the number of cases with metastatic eye tumors is increasing. We present a case of a patient who was diagnosed with lung cancer following a hospital visit for decreased visual acuity and had an uneventful course.
Case: A 39-year-old woman with a chief complaint of decreased visual acuity in her left eye was referred to department of ophthalmology of our hospital for further examination and treatment. Yellow-white raised lesions in the macula and partial exudative retinal detachment (ERD) were found in her left eye. Hence, metastatic choroidal tumor was suspected. As positron emission tomography-computed tomography (PET-CT) scan revealed uptake in the right lung and posterior segment of the left eye, we consulted the department of thoracic surgery for the investigation of primary lung tumor, and lung adenocarcinoma was diagnosed. Because the patient had Stage IV lung cancer with choroidal metastasis and an anaplastic lymphoma kinase (ALK) gene mutation, treatment using the ALK inhibitor crizotinib was started. At the beginning of treatment, visual acuity of the left eye decreased to 0.04 due to the expansion of ERD that involved the macula. After 16 months of treatment, the ERD disappeared and visual acuity of the left eye improved to 0.6. However, 2 years of the treatment, a lesion suspected to be new metastasis around the optic disk was detected, and magnetic resonance imaging (MRI) showed metastasis in the right frontal cortex. Following this, the medication was changed to alectinib, which has a better ability to penetrate to the blood-brain barrier. As a result, brain and peripapillary optic nerve head metastases disappeared.
Conclusion: Currently, 6 years have passed since the start of treatment; however, there has been no recurrence of the primary tumor, and the patient has maintained good visual function.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 126: 814-819,2022.