Retinal cases & brief reports · 2025
Uveal Effusion in Neuroendocrine Carcinoma Metastatic to the Choroid Treated with Gamma Knife Stereotactic Radiosurgery.
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Uner Ogul E, Kee Andrew Y, Thanos Aristomenis
Аннотация
PURPOSE: To report the use of Gamma Knife stereotactic radiosurgery in the treatment of refractory uveal effusion in the setting of choroidal metastasis and checkpoint inhibitor therapy.
METHODS: Review of a case of metastatic bronchial neuroendocrine carcinoma to the choroid that developed refractory unilateral uveal effusion after checkpoint inhibitor therapy initiation.
RESULTS: A 47-year-old Caucasian female with stage T1bN3M1 bronchial neuroendocrine carcinoma metastatic to the brain and stage 1A, grade 1 endometrial carcinoma status post hysterectomy was referred to the retina service for evaluation of a choroidal mass identified in brain MRI. Two weeks after starting atezolizumab, vision declined to 20/200 with new serous uveal effusion solely in the left eye. Systemic therapy was continued as it was life-prolonging, but the uveal effusion was refractory to topical and periocular corticosteroids. Gamma Knife stereotactic radiosurgery was delivered to the left choroidal metastasis, with resolution of the uveal effusions within 2 weeks. The patient completed her last cycle of atezolizumab, vision remained stable, and no new effusions were noted 1 month after radiotherapy.
CONCLUSION: Checkpoint inhibitor-associated uveal effusion can occur in eyes with intraocular metastases, presumably due to a crosstalk between the tumor microenvironment and the immune system. Gamma Knife radiotherapy to solitary choroidal metastases may aid in rapid resolution of refractory uveal effusions, especially in patients who cannot stop the life-prolonging treatment.
METHODS: Review of a case of metastatic bronchial neuroendocrine carcinoma to the choroid that developed refractory unilateral uveal effusion after checkpoint inhibitor therapy initiation.
RESULTS: A 47-year-old Caucasian female with stage T1bN3M1 bronchial neuroendocrine carcinoma metastatic to the brain and stage 1A, grade 1 endometrial carcinoma status post hysterectomy was referred to the retina service for evaluation of a choroidal mass identified in brain MRI. Two weeks after starting atezolizumab, vision declined to 20/200 with new serous uveal effusion solely in the left eye. Systemic therapy was continued as it was life-prolonging, but the uveal effusion was refractory to topical and periocular corticosteroids. Gamma Knife stereotactic radiosurgery was delivered to the left choroidal metastasis, with resolution of the uveal effusions within 2 weeks. The patient completed her last cycle of atezolizumab, vision remained stable, and no new effusions were noted 1 month after radiotherapy.
CONCLUSION: Checkpoint inhibitor-associated uveal effusion can occur in eyes with intraocular metastases, presumably due to a crosstalk between the tumor microenvironment and the immune system. Gamma Knife radiotherapy to solitary choroidal metastases may aid in rapid resolution of refractory uveal effusions, especially in patients who cannot stop the life-prolonging treatment.