Diagnostic approach to choroidal metastases

Abstract

Intraocular metastases account for 64-67% of all metastatic ocular tumors, of them 88-90.7% are found in the choroid. By the time the metastasis is diagnosed, 30-44% of patients usually have their primary lesion identified. In oncology patients with multiple and/or bilateral choroidal involvement, the diagnosis can be easily determined at ophthalmoscopy, while in those whose anamnesis is unburdened, this task is quite challenging. Aim - to define diagnostic criteria of choroidal metastases that would consider data provided by state-of-the-art instrumental assessment. Material and methods. The study enrolled 5 patients (3 women and 2 men) with choroidal metastases of different origin. The mean patient age at the time of ocular involvement was 47.8 years (38-60 years). Oncological anamnesis was burdened in only 2 cases. Results. Due to the small number of cases and diverse clinical presentation, we considered appropriate to describe each case separately. Conclusion. The absence of a known preexisting lesion is typical of the younger age group. By analyzing optical coherence tomography data, we are able to list the most common signs of all choroidal metastases: hummocky profile of the choroid and a high neuroepithelium detachment accompanied by edema and photoreceptor damage. Fluorescein angiography diagnostic criteria are the following: spotted hyperfluorescence that begins in the arterial phase and gradually increases in intensity, while choroidal fluorescence is blocked during the whole examination; almost confluent hyperfluorescence with brighter pin-points along the margin of the lesion seen in the later phases. Evaluation of autofluorescence is auxiliary, but can provide an idea of the disease duration.