Metastatic choriocarcinoma to the choroid with concurrent optic nerve involvement: a case report and review of the literature.

PURPOSE: To describe a case of choroidal metastasis of choriocarcinoma, which presented as a rapidly progressive hemorrhagic retinal detachment with concurrent optic nerve involvement suggestive of inflammation or metastasis. METHOD: This is a case report of a 43-year-old patient with a known history of choriocarcinoma metastases to both lungs who presented with 1 week of right eye pain and decreased vision. Dilated fundus examination was significant for a large, bullous, hemorrhagic retinal detachment, with the appearance of an underlying choroidal mass in the superonasal retina. Magnetic resonance imaging result was significant for a 1.6 × 1.3-cm heterogeneous mass in the right globe, suggestive of metastasis, and inflammatory changes in the sclera, optic nerve, and optic nerve sheath. Additionally, hemorrhagic metastases were found in the right occipital and left frontal lobes. RESULTS: To our knowledge, this is the first case of metastatic choriocarcinoma to the choroid with concurrent optic nerve involvement. CONCLUSION: Choroidal metastases may be diagnosed in the setting of more widespread central nervous system involvement and should be investigated accordingly.

Orbital decompression: current concepts.

The orbit in Graves disease undergoes expansion in soft tissue content as a result of the infiltration of orbital fat, extraocular muscles, and the lacrimal gland. Compression of the intraorbital contents leads to disorders of the lid-corneal interface, keratopathy, motility disturbances, exophthalmos, and optic neuropathy. Orbital decompression has traditionally been reserved for those patients with unremitting optic neuropathy. This article provides a historical review of orbital decompression, as well as a review of the evolution of surgical approaches toward both soft tissue and bony decompression. Recent trends in surgical management include fat decompression, more extensive posterior sculpting of the lateral wall, and direct approaches to the medial wall. Preoperative predictors of diplopia and hypoglobus are addressed, as are the various techniques that are employed to limit new postoperative strabismus. The roles of endoscopy and combined surgical techniques are also reviewed. Expanded indications for decompression and its effect on increased intraocular pressure are discussed as well.