Vitreous Hemorrhage as the Presenting Ocular Feature of Choroid Metastasis from Lung Cancer: A Case Report

Purpose: To report a case of choroidal metastasis from lung cancer with vitreous hemorrhage as the presenting ocular feature. Methods: A case report. Result: A 51-year-old female with a history of lung cancer was referred to our hospital because of sudden-onset visual field defect and blurred vision in the left eye experienced for one day. The best corrected visual acuity of her left eye was counting fingers at 25 cm. Ocular examination results were normal except for vitreous hemorrhage and a yellowish elevated mass at the left eye's superonasal quadrant fundus. B-scanning of the left eye demonstrated a dome-surfaced, elevated choroidal lesion with moderated internal reflectivity. Orbital magnetic resonance imaging (MRI) revealed a rounded lesion in the left eyeball that was 5.2 mm in vertical length, 4.6 mm in height and 7.5 mm in horizontal length. Lung cancer with choroidal metastasis was highly suspected. Because the patient refused radiotherapy, a 23-gauge pars plana vitrectomy (PPVT) and intravitreal bevacizumab injection were performed. At follow-up, the best corrected visual acuity (BCVA) had improved and the size of the choroidal mass had regressed. Conclusion: Although it is rare, vitreous hemorrhage can be the presenting ocular feature of choroidal metastasis from lung cancer. For patients with a diagnosis of vitreous hemorrhage from choroidal metastasis who refuse radio-therapy, vitrectomy with intravitreal bevacizumab may be a choice to improve quality of life.