A Rare Differential Diagnosis of Neovascular Age-Related Macular Degeneration: Choroidal Metastasis

Abstract

We present the case of 80-year-old patient with choroidal metastasis that was initially misdiagnosed as neovascular age-related macular degeneration (n-AMD) because of the presence of subretinal fluid. He received four intravitreal ranibizumab injections within six months before he was referred to our retina clinic due to unresponsiveness. A clinical diagnosis of choroidal metastasis from an advanced pulmonary adenocarcinoma was made with an interdisciplinary approach. Three doses of intravitreal aflibercept (AFL) were administered with 9 concurrent cycles of systemic chemotherapy over 13 months. Visual acuity improved from 20/125 to 20/63; complete resolution of the mass was obtained with residual pigmentary and atrophic changes. This regression was sustained during follow-up period, even though the systemic disease progressed. This is the first report of successful combination therapy of intravitreal AFL and systemic chemotherapy. Despite being rare, choroidal metastasis should be considered as a differential diagnosis of n-AMD.