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To report the effectiveness of indocyanine green mediated photothrombosis (IMP) combined with high dose (4 mg/0.16 ml) intravitreal bevacizumab (IVB) as adjunctive therapy for management of isolated choroidal metastasis from breast cancer. This retrospective interventional case report includes three eyes of two patients with choroidal metastasis from breast cancer. Both patients were submitted to one session of IMP combined with high dose IVB as adjuvant local therapy to systemic chemotherapy. Main outcome measures were tumor response, and fluorescein angiography (FA), optical coherence tomography (OCT), and visual acuity (VA) results. The first patient was a 47-year-old woman who had undergone radical mastectomy, chemotherapy and radiotherapy 7 years earlier and the second patient was a 70-year-old woman managed with chemotherapy and radiotherapy 16 years before presentation. There was no evidence of systemic metastasis in either case and both suffered from gradually blurred vision. The first patient presented with a unilateral choroidal lesion whereas the second case had bilateral unifocal choroidal lesions which was symptomatic in only one eye. Clinical examination, ultrasonography, FA, and OCT revealed accompanying exudative retinal detachment in all three eyes. OCT 3 to 5 weeks after combined therapy demonstrated complete resolution of subretinal fluid and improved VA in two eyes. Combined IMP and high-dose IVB seems to be an effective adjunctive treatment to systemic chemotherapy for management of isolated choroidal metastasis from breast cancer.

Background: Breast cancer remains a leading cause of cancer-related mortality and morbidity worldwide. Ocular and periocular metastasis present as a rare but clinically significant manifestation. This study aims to explore demographics and clinical aspects of ocular and periocular metastasis in breast cancer patients. Methods: A retrospective cohort study comprising 45 breast cancer patients with ocular or periocular metastasis treated between 2013 and 2023. Patient demographics, tumor characteristics, diagnostic methods, treatment modalities, visual outcomes, and survival data were analyzed. Results: Among 9902 breast cancer patients, 0.5% developed ocular or periocular metastasis, constituting 2.4% of metastatic cases. The median age was 50 years. Ocular metastasis timing varied: 5% before breast cancer, 24% concurrent, 22% within a year, and 49% after. The most common presentations included incidental MRI findings (42%) and vision decline (31%). Metastasis involved the orbit (47%), choroid (40%), optic nerve (11%), and iris (2%), with 44% having bilateral involvement. Predictive factors included invasive lobular carcinoma (ILC) (p < 0.0001) and brain metastasis (p < 0.0001), with ILC exhibiting a sixfold higher likelihood of ocular metastasis than invasive ductal carcinoma (IDC). Primary treatment was radiation therapy (89%), yielding a 55% maintenance of excellent vision (<0.5), with 93% developing dry eye disease. Patients with ocular metastasis faced an increased risk of disease-related mortality (p < 0.0001), with 71% succumbing within 10 months post-diagnosis. Conclusions: Ocular metastasis in breast cancer is rare (0.5%) but signifies poor outcome. It is linked to ILC and concurrent brain metastasis. Primary treatment involves radiation therapy, with a favorable visual prognosis.

Purpose To study the incidence and characteristics of bacillary layer detachment (BALAD) occurring with the two most common choroidal malignancies, choroidal metastasis and choroidal melanoma. Methods A retrospective multicentric record analysis. Eyes with a diagnosis of choroidal melanoma or choroidal metastasis that had good-quality fundus photography and spectral domain optical coherence tomography (OCT) scans of the macular and tumor regions allowing for delineation of the retinal layers were included for analysis. Qualitative image evaluation was done by two independent graders for the presence, location, and OCT features of BALAD, as well as any associated intraretinal or subretinal fluid. Demographic and clinical data were also retrieved. Results Of the 11 eyes with choroidal metastasis and 7 eyes with choroidal melanoma that were included in the final analysis, 6 (54.5%) and 1 (14.3%) had BALAD, respectively. The BALAD co-localized with the subretinal fluid in all cases and with the intraretinal fluid in 1/3 cases (33.3%), was foveal in location in 3 eyes (42.9%), was overlying the tumor in 6 eyes (85.7%), and varied in number and size. Reflectivity within the BALAD was consistently higher than the vitreous and adjacent subretinal fluid, and discernable suspended hyperreflective particles were noted in 5 eyes (71.4%). Conclusion BALAD is relatively common with choroidal metastasis. The OCT features described supplement our recognition of this new entity.

Metastases in the choroid originating from small cell lung cancer (SCLC) remain rare. The diagnosis of ocular metastases and primary lung tumors in individuals with SCLC can be challenging and time-consuming, particularly when their first symptoms present as ocular. The treatment of patients with ocular metastases of lung cancer is another clinical challenge in terms of primary tumor control and metastasis suppression. The current study presents the case of a 62-year-old man admitted to The Second Hospital of Jilin University (Jilin, China) for blurred vision. Based on subsequent clinical and pathological features of the patient, choroidal metastasis was suspected. Upon examination, the patient was diagnosed with serous retinal detachment, pleural effusion, choroidal metastases and SCLC of the right lung. Patients with the aforementioned condition receive chemotherapy and radiotherapy. First-line chemotherapy regimens consisted of etoposide and nedaplatin, while second-line regimens consisted of liposomal paclitaxel combined with lobaplatin. The condition of the patient was controlled during the first treatment period, which led to a temporary improvement in quality of life. However, the disease rapidly progressed, and the patient declined further treatment and ultimately succumbed to his illness. Visual symptoms may be the first indication of malignant tumors; therefore, ocular symptoms should be vigilantly monitored in patients diagnosed with malignant tumors. Furthermore, palliative care, psychological support and socioeconomic assistance are key to the quality of life of patients. Adoption of a patient-centered approach to provide comfort can also optimize treatment outcomes and improve the quality of life of patients.

AbstractIntroduction: We report the clinical, imaging, histopathological, and genetic features of a choroidal metastasis originating from a cutaneous melanoma. Case Presentation: A 92-year-old woman presented with an asymptomatic pigmented lesion in her right eye. She had a history of prior cutaneous melanoma. Workup revealed widespread metastases to the liver, lungs, and brain. Histopathology (post-mortem eye) showed melanoma cells of the epithelioid cell type. Genetic analysis was positive for the BRAF V600K variant, confirming the cutaneous origin of the choroidal tumour. Conclusion: Choroidal metastasis of a cutaneous melanoma is a rare manifestation that can be mistaken for a primary choroidal melanoma. A comprehensive clinical history, histopathology, and genetic analysis are useful in distinguishing between the two entities.

INTRODUCTION: Choroidal metastasis from colorectal cancer is extremely rare, accounting for approximately only 4% of all choroidal metastases. However, with the increasing incidence and improved survival rates of colorectal cancer, the importance of diagnosing and treating ocular metastases is growing. We report a case of choroidal metastasis from colorectal cancer and review the relevant literature.CASE PRESENTATION: A 67-year-old man underwent curative surgery and adjuvant chemotherapy for ascending colon cancer. Two years later, pulmonary recurrence was detected and surgically resected. At 2 years and 5 months postoperatively, he developed visual impairment in the left eye, which led to the diagnosis of choroidal metastasis. A combination of systemic chemotherapy and local radiotherapy resulted in tumor shrinkage and relief of ocular pain. With additional local treatments administered in response to subsequent recurrences, the patient achieved long-term survival—5 years and 6 months after surgery and 3 years after the diagnosis of choroidal metastasis. A review of 22 reported cases of choroidal metastasis from colorectal cancer published since 2000 revealed that most patients had multi-organ metastases at the time of diagnosis. The average survival following the diagnosis of ocular metastasis was 10.4 months, indicating a poor prognosis. By contrast, local treatments—such as radiotherapy and intravitreal injections—contributed to symptom relief and the maintenance of quality of life. This case represents a valuable example of long-term survival achieved through combined local therapies.CONCLUSIONS: Although choroidal metastasis from colorectal cancer is rare, clinical management should consider the possibility of ocular involvement. A multidisciplinary approach combining systemic therapy with local treatments is essential for maintaining quality of life and prolonging survival.

Introduction: Approximately 5% of patients with cutaneous melanoma develop distant metastases, and very rarely, can involve the eye and orbit. This case report discusses a patient with an unusual presentation of choroidal metastasis secondary to cutaneous melanoma. Case Presentation: A 76-year-old man with a past medical history of cutaneous melanoma on the right shoulder status post radiation presented to the ocular oncology clinic with a 3-month history of decreased vision, occasional pain, and floaters in the right eye. Initial examination revealed a visual acuity of hand motion in the right eye, intraocular pressure of 5 mm Hg, and no view to the fundus due to vitreous hemorrhage. B-scan did not show a retinal tear, retinal detachment, or intraocular tumor. The patient underwent pars plana vitrectomy of the right eye where massive choroidal thickening with subretinal yellow deposits obstructing the optic nerve head was seen, initially concerning lymphoma. On postoperative week one, visual acuity remained hand motion and the fundus exam showed clear vitreous and retinal/choroidal infiltrates obscuring the optic nerve and macula. Repeat B-scan showed retinal and choroidal thickening with exudates. Cytology results from surgery later revealed malignant cells consistent with melanoma. The patient underwent ocular radiation but eventually progressed to no light perception visual acuity. He is currently under observation with the goal of palliative care. Conclusion: This case highlights the importance of maintaining a high level of suspicion for metastasis in the setting of melanoma history even when presentation can be atypical. Early recognition of choroidal metastasis allows for timely intervention, improving the chances of preserving vision.

Choroidal metastatic tumours from gastric cancer (GC) are rare compared with breast and lung cancer. Here, we report a patient with GC who presented to our ophthalmology clinic with a one-week history of left eye visual disorder and pain. Fundoscopic and B-scan examinations suggested a choroidal metastatic tumour. Computed tomography (CT) and magnetic resonance imaging (MRI) scans confirmed our initial diagnosis. Histopathology and immunohistochemical findings showed the tumour most likely originated from the gastrointestinal tract. Although the patient was well after eye removal, he died two months after surgery. Metastasis of GC should be a consideration when a patient with a history of GC presents with eye pain, decreased vision, and/or high intraocular pressure.

Abstract We describe the case of a 69-year-old woman who presented with a decline in vision in the left eye and was found to have a choroidal lesion with clinical and echographic features concerning for primary uveal melanoma. Systemic imaging identified numerous metastases to the liver, kidneys, paratracheal lymph nodes, lung, and brain. The hepatic lesion was biopsied, and genetic analysis identified a Val600Glu (c.1799T>A) BRAF mutation, consistent with a cutaneous primary malignancy, although no primary tumor was identified. This case highlights that metastasis to the choroid is a rare presentation of nonuveal melanoma that can mimic primary uveal melanoma. Genetic analysis of tumor tissue can identify the origin of the melanoma and guide treatment options. Systemic imaging should be performed prior to intervention for choroidal neoplasms.

Metastatic choroidal carcinoma is rare and generally has a poor prognosis. The present case report describes a case of choroidal metastasis from distal cholangiocarcinoma, which was successfully managed using stereotactic radiotherapy (SRT). A 67-year-old Japanese man underwent pancreaticoduodenectomy for distal cholangiocarcinoma. The pathological stage was T2N0M0 stage IIA, according to the Union for International Cancer Control 8th edition. After surgery, the patient received adjuvant chemotherapy with oral TS-1® for 1 month. A total of 2 months after surgery, the patient was readmitted to hospital due to decreased visual acuity. Fundoscopy revealed a macular hole in the right eye that accounted for the decreased visual acuity. Additionally, Goldmann three-mirror contact lens examination revealed a 4-mm choroidal mass with a yellowish color situated at a considerable distance from the optic nerve. Magnetic resonance imaging revealed an enhanced choroidal mass. Based on the findings of ophthalmologic examinations and the patient's history of cholangiocarcinoma, they were diagnosed with choroidal metastasis from distal cholangiocarcinoma. SRT was administered at a total dose of 40 Gy divided into 8 Gy fractions. A total of 1 year after SRT, the patient achieved complete remission without decreased visual acuity. The patient remains alive and in good health without recurrence, 4 years after the diagnosis of choroidal metastasis. To the best of our knowledge, this is the second reported case of intraocular metastasis from cholangiocarcinoma. In conclusion, SRT may provide an opportunity to control metastatic choroidal carcinoma without decreasing visual acuity.