This 87YO male presented with recent blurred vision in his right eye. Vision was 20/200 OD. He has a medical history of hypertension and prostate cancer that was successfully treated with radiation 15 years earlier.
Optos color imaging shows a creamy white subretinal discoloration in the nasal macula extending inferiorly.
Fundus autofluorescence (FAF) shows mostly hyper-FAF within this region. Swept-source OCT through the macular center shows severe cystic fluid in the outer nuclear layers and milder fluid in the inner nuclear layers. An unusual collection of outer vs subfoveal fluid is also seen. A B-scan through the inferior macula shows subretinal fluid.
The patient was referred to his oncologist for a metastatic workup, which disclosed previously undiagnosed colon cancer.
Learning Points:
Although uveal melanoma is the most common primary intraocular malignancy, metastatic choroidal tumors are the most common intraocular malignancies.
Lung and breast cancer are the most common sources. Prostate cancer rarely metastasizes to the choroid, found in only 2% of uveal metastases (Shields et al, Retina 2020;40:204-213).
