Retinal metastasis from systemic cancer in 8 cases

• Published in: JAMA ophthalmology Vol. 132; no. 11; p. 1303
• Main Authors: Shields, Carol L, McMahon, Jeffrey F, Atalay, Hatice T, Hasanreisoglu, Murat, Shields, Jerry A
• Format: Journal Article
• Language: English
• Published: United States 01-11-2014
• Subjects: Aged; Aged, 80 and over; Brachytherapy; Breast Neoplasms - pathology; Carcinoma - diagnosis; Carcinoma - secondary; Carcinoma - therapy; Diagnosis, Differential; Esophageal Neoplasms - pathology; Eye Enucleation; Female; Fluorescein Angiography; Humans; Lung Neoplasms - pathology; Male; Melanoma - diagnosis; Melanoma - secondary; Melanoma - therapy; Middle Aged; Retinal Neoplasms - diagnosis; Retinal Neoplasms - secondary; Retinal Neoplasms - therapy; Retrospective Studies; Skin Neoplasms - pathology; Tomography, Optical Coherence; Visual Acuity - physiology
• ISSN: 2168-6173
• DOI: 10.1001/jamaophthalmol.2014.2406

Metastatic tumors of the retina are rare, simulate retinitis, and are associated with poor patient survival.
To describe the clinical features and outcomes of patients with retinal metastasis from systemic cancer.
Retrospective case series of 8 patients with retinal metastasis from cutaneous melanoma (n = 4), breast cancer (n =2), esophageal cancer (n =1), and lung cancer (n = 1). At presentation, the mean patient age was 62 years and all were white.
Treatment included plaque radiotherapy (n = 1) for localized disease or enucleation (n =3) for extensive tumor hemorrhage (n = 1), total retinal detachment (n = 1), or pain (n = 1). For 4 preterminal patients, observation was preferred.
Clinical features and systemic outcomes.
The mean interval from primary cancer diagnosis to retinal metastasis was 63 months. Initial misdiagnosis as retinitis (n = 5), hemangioma (n = 1), choroidal neovascular membrane (n = 1), or nerve fiber layer infarction (n = 1) for a mean interval of 5 months was recorded. Visual acuity in the affected eye was 20/40 to 20/60 (n = 5) or 20/400 to light perception (n = 3). The tumors were unilateral (n = 7), involved the macula (n = 3), and had a mean distance to the foveola of 6 mm. In one case, dense vitreous blood precluded fundus visualization. The mean tumor basal dimension was 7.4 mm, and the mean thickness was 2.3 mm. The tumors appeared white (n = 2), yellow (n = 4), or brown (n = 1); were located in the inner retina (n = 6) or full-thickness retina (n = 1); and had vitreous seeds (n = 3), vitreous hemorrhage (n = 2), retinal hemorrhage (n = 4), subretinal fluid (n = 4), and/or intraretinal exudation (n = 1). Fluorescein angiography disclosed early retinal hypofluorescence and late hyperfluorescence with staining. Fine-needle aspiration biopsy confirmed the diagnoses (n = 4). Metastasis-related death occurred in 5 patients within 1 month in each case. Of the remaining 3 patients, 2 were alive at 4 and 17 months and 1 was too sick to return.
Retinal metastases resemble retinitis, often with delay in diagnosis and poor life prognosis.