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Optical coherence tomography characteristics of choroidal metastasis.

Arevalo JF, Fernandez CF, Garcia RA

Retina and Vitreous Service, Clínica Oftalmológica Centro Caracas, Caracas, Venezuela. areval1@telcel.net.ve

PURPOSE: To report 4 patients (7 eyes) with choroidal metastasis (primary: breast [2], lung [1], and unknown [1]) visualized with optical coherence tomography (OCT). DESIGN: Retrospective case series. PARTICIPANTS: Four patients (7 eyes) with choroidal metastasis participated in the study. METHODS: Clinical examination, ultrasonography, fluorescein angiography, and OCT were performed in all cases. MAIN OUTCOME MEASURES: Optical coherence tomography characteristics. RESULTS: Three patients suffered a gradual onset of blurred vision in both eyes. The fourth presented a unilateral decrease in visual acuity. Bilateral choroidal lesions with various degrees of exudative retinal detachment (RD) were present in 3 of our 4 patients, and there was 1 case of a unilateral unifocal choroidal lesion. Optical coherence tomography revealed anterior displacement of the photoreceptor layer by subretinal fluid (hyporeflective space) overlying a hyperreflective thickened retinal pigment epithelium-choriocapillaris complex. Subretinal deposits with several degrees of hyperreflectivity were seen, as well as loss of normal retinal architecture with intraretinal splitting, identified as regions of low reflectance within the neurosensory retina. After chemotherapy, OCT demonstrated improvement of the serous RD and reduction of the lesion's size with recovery of the normal retinal architecture. CONCLUSIONS: Optical coherence tomography in patients with choroidal metastasis allows evaluation of secondary retinal-retinal pigment epithelial changes. In addition, the technique is useful in the follow-up of lesions after treatment. However, some limitations result from the choroidal location of the metastasis. Further studies with clinicopathological correlation are needed to confirm our observations.

Published 5 September 2005 in Ophthalmology, 112(9): 1612-9.
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