Ocular Oncology

Case 7

Contributors: Mohammed Al Falah and Miguel Cruz Pimentel

Patient Presentation: 
A 44-year-old female was referred to a tertiary retina centre for vision loss in the left eye for 3 weeks. Her past ocular history was unremarkable. Her past medical history was significant for advanced breast cancer with known bone metastasis requiring chemotherapy. She denied pain or red eye, but she did note occasional flashes in the periphery over the last few days.

 

On examination, her best corrected visual acuity was 20/25 OD and 20/400 OS. Her IOP was 12 mmHg OD and 15 mmHg OS. The anterior segment examination was normal, with no signs of inflammation. Fundus examination of the right eye was within normal limits. Fundus examination of the left eye revealed a hyperemic optic nerve swelling as well as an elevated non-pigmented choroidal lesion inferior to the optic nerve. The lesion is at least 10 DD in size with an extension to the macula and subfoveal area.

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The accompanying OCT macula of the left eye shows the following:

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Question 1: Describe the OCT findings above.

Question 2: What is the diagnosis?

Question 3: What are other primary sites of choroidal metastasis than breast cancer?

Question 4: In addition to ongoing chemotherapy and/or hormonal therapy, what local therapies can be used to treat this patient?

The patient was referred to radiation oncology service and she was treated with EBRT. At three months follow-up, OCT imaging of the left eye revealed a regressed choroidal mass, resolution of all subretinal fluid, with some residual irregularity and disruption within the EZ and the RPE.

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Fundus photo 3 months post radiation shows resolution of optic nerve swelling and regression of the choroidal mass. The patient’s BCVA was 20/60 at 3 months.

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Question 5: What are some complications associated with radiotherapy to the eye?