A Case Report of Intravitreal Aflibercept for Iris Metastasis from Small Cell Lung Carcinoma with Neovascular Glaucoma.

Introduction: Metastatic iris tumors from lung cancer are uncommon and challenging to diagnose. As lung cancer treatments improve, life expectancy increases, potentially leading to more cases of metastasis. These tumors often cause neovascular glaucoma, making intraocular pressure (IOP) management crucial, especially in terminal-stage patients.

Case presentation: A 65-year-old man with small cell lung carcinoma (SCLC) presented with right ocular pain and blurred vision. His right IOP was 55 mm Hg, and examination revealed anterior chamber cells, multiple grayish-white iris masses, and right iris neovascularization. Anterior chamber fluid cytology confirmed the diagnosis of metastatic iris tumors from SCLC. Despite treatment with topical eye drops, oral acetazolamide, and intravenous hypertonic mannitol, the IOP remained poorly controlled. Intravitreal aflibercept was subsequently administered into his right eye for neovascular glaucoma. Neovascular glaucoma disappeared rapidly, but IOP did not improve. However, intravenous infusion of hypertonic mannitol was no longer required, and the complaints of nausea associated with IOP decreased. Although this patient died 4 months after the initial visit due to multiple metastases of SCLC, the intravitreal aflibercept was effective in shrinking the iris tumor size and lowering IOP in the terminal phase of the disease.

Conclusion: This is the first reported use of intravitreal aflibercept for SCLC metastases to the iris. While the prognosis of patients with metastatic iris tumors remains poor, intravitreal aflibercept injections show potential in reducing iris tumor size and lowering IOP. Although not curative, this therapeutic approach may play a significant role in the symptom management of these patients.