Peripapillary and circumpapillary retinal intraocular metastases are rare and present a treatment challenge for ophthalmologists because of the high risk of iatrogenic injury to the optic nerve. There are no clear guidelines on the management of these lesions, and many clinicians will initially observe for improvement of the metastases with systemic chemotherapy before considering local therapy with external beam radiation. Radiation to the optic disc carries a significant risk of injuring the optic nerve, leading to worsening of vision. Alternative treatment approaches are needed. We present a patient with large-cell neuroendocrine carcinoma with metastasis to the peripapillary retina who was treated with intravitreal topotecan and with intravitreal aflibercept. Serial fundus photos, ultrasound, and optical coherence tomography demonstrated a reduction in size of the lesion and a decrease in subretinal fluid with intravitreal topotecan and aflibercept. In addition, visual acuity was stabilized during treatment. Intravitreal chemotherapy for intraocular metastases in vision-sensitive areas such as the peripapillary retina may be a viable alternative for patients who seek to preserve their vision and maintain their quality of life.
Ocul Oncol Pathol

中文翻译：

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视乳头周围神经内分泌癌转移：一种新的治疗方法

由于视神经医源性损伤的高风险，视乳头周围和视乳头周围视网膜眼内转移是罕见的并且对眼科医生提出了治疗挑战。对于这些病变的管理没有明确的指导方针，许多临床医生在考虑使用外照射进行局部治疗之前，会先观察全身化疗对转移灶的改善情况。对视盘的辐射具有损伤视神经的显着风险，导致视力恶化。需要替代治疗方法。我们介绍了一名患有大细胞神经内分泌癌并转移至视乳头周围视网膜的患者，该患者接受了玻璃体内托泊替康和玻璃体内阿柏西普治疗。系列眼底照片，超声，和光学相干断层扫描显示，玻璃体内托泊替康和阿柏西普可使病变缩小，视网膜下液减少。此外，治疗期间视力稳定。对于寻求保护视力和维持生活质量的患者来说，用于视觉敏感区域（例如视盘周围视网膜）的眼内转移的玻璃体内化疗可能是一种可行的替代方案。
眼肿瘤病理