Multimodal imaging and functional outcomes of choroidal metastases from non-small cell lung cancer treated with targeted therapy

PurposeTo evaluate the long-term outcomes of next-generation tyrosine kinase inhibitor (TKI) therapy in patients with choroidal metastases (CMs) secondary to non-small cell lung cancer (NSCLC).Major FindingsThis case series includes five eyes from three patients with stage IV NSCLC and CMs. All patients presented with unilateral visual loss, though two exhibited bilateral choroidal lesions on multimodal imaging, including fundus photography, dye-based angiography, optical coherence tomography (OCT), and ultrasonography. Systemic evaluation confirmed ALK-rearranged NSCLC (case 1) and EGFR-mutated NSCLC (cases 2 and 3), leading to first-line treatment with Alectinib and Osimertinib, respectively. Within months of therapy initiation, significant anatomical and visual improvements were noted, with complete lesion resolution and photoreceptor restoration by 6 months. At final follow-up (24-36 months), high-resolution OCT showed residual granularity in the outer retinal layers, while OCT angiography (OCTA) revealed persistent choriocapillaris flow voids. Microperimetry demonstrated distinct functional alterations based on lesion location.ConclusionsThis series highlights favorable long-term outcomes in NSCLC patients with CMs treated with next-generation TKIs. It underscores the value of multimodal imaging and functional assessments in monitoring disease progression and treatment response, emphasizing the importance of early targeted therapy in optimizing visual outcomes.