Choroidal metastases: clinical and echographic patterns

ABSTRACT

The purpose of this study is to report the clinical and echographic data from a retrospective series of patients diagnosed of having choroidal metastases. This study included twenty two patients [26 eyes] with choroidal metastases. They were fifteen females and seven males. Their ages ranged from 35-65 years. All the patients were subjected to careful history taking, thorough ophthalmic examination and ultrasonography. At the time of ocular diagnosis of choroidal metastases, 14 patients [63.6%] reported a history of malignancy, while 8 patients [36.4%] had no knowledge about their malignancy. After systemic work up, in the fifteen female patients the primary malignancy site was breast cancer in 12 patients [80%], lung cancer in one patient [6.7%] and unknown in two patients [13.3%], while in the 7 male patients the primary malignancy site was lung cancer in four patients. [57.1%], colon cancer in one patient [14.3%] and unknown in two patients [28.6%]. On ophthalmoscopy visible tumors appeared as yellow or creamy yellow subretinal mass lesions. Exudative retinal detachment was noted in 84.6% of the eyes. On ultrasonography, in 5 eyes [19.2%] the tumors were dome-shaped, and in 21 eyes [80.8%] the tumors were flat and diffuse. In 25 eyes [96.2%] these metastatic tumors had medium to high intemal reflectivity with irregular internal structure, and in only one eye [3.8%] the tumor had medium to low internal reflectivity with irregular internal structure. Bullous non rhegmatogenous retinal detachment and/or choroidal metastases can be the first manifestation of cancer. Ultrasonography, using A- and B-mode criteria, offers an opportunity for high accuracy in the diagnosis of choroidal metastases. The best set of echographic parameters for differentiation of choroidal metastases is moderate to high internal reflectivity, irregular internal structure and a flat shape with irregular surface contour. Routine ophthahlic examination should be included as a part of evaluation of patients with cancers. Prompt detection can provide the patients access to therapeutic modalities reducing their ocular morbidity as well as, overall morbidity and mortality