Overview
The most common type of ocular malignancy, typically affecting the choroid
Uveal metastasis most commonly originates in the breast or lung
- Most commonly affects Caucasian females >60 years of age
Overall 5-year-survival is <25%, with mean survival of <24 months
Exam
Symptoms: blurry vision, flashes, and floaters; asymptomatic in 10% of cases
- Commonly presents as a yellow subretinal mass with associated subretinal fluid
Typically unilateral, with one to two lesions present
Average lesional dimensions: 9 mm in diameter, 3 mm thick
Imaging
- Fundus autofluorescence
Tumor hypoautofluorescence with areas of overlying hyperautofluorescence corresponding to lipofuscin and subretinal fluid
- Ultrasonography
Amplitude scan (A-scan): Highly reflective mass
Brightness scan (B-scan): Hyper-echogenic mass with a low height-to-base ratio
- Ocular coherence tomography (OCT)
Subretinal fluid with choroidal undulations (“lumpy bumpy” appearance)
- Fluorescein angiography
Early hypofluorescence with late hyperfluorescence
Pinpoint leakage at the tumor margin
- Magnetic resonance imaging (MRI)
Well-demarcated choroidal mass that is isointense on T1- and hypointense on T2-weighted images
Differential Diagnosis
Primary uveal melanoma
Hemangioma
Granuloma
Treatment
Systemic chemotherapy
Plaque radiotherapy
Transpupillary thermoplasty
Enucleation for painful eye or observation if prognosis is poor
Other therapies include: proton beam radiotherapy, gamma knife radiosurgery, external beam radiotherapy, photodynamic therapy, or intravitreal anti-vascular endothelial growth factor (VEGF) injections