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Metastatic neoplasms in the optic disc: the 1999 Bjerrum Lecture: part 2
J A Shields1, C L Shields, A D Singh
1Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Background:
Little information is available on metastatic tumors to the optic disc.
Objective:
To determine the clinical features and prognosis of patients with optic disc metastasis.
Design:
Retrospective chart review.
Results:
Of 660 consecutively evaluated patients with intraocular metastasis, 30 (4.5%) (31 eyes) had metastatic cancer to the optic disc; 24 (80%) were women and 6 (20%) were men. Mean age at the time of ocular diagnosis was 55 years. The primary neoplasm was in the breast in 13 patients (43%), in the lung in 8 (27%), in the intestine in 1 (3%), in the kidney in 1 (3%), and in the prostate in 1 (3%); the primary neoplasm was never determined in 6 patients (20%). The optic disc metastasis was unilateral in 29 patients (97%) and bilateral in 1 (3%). Ophthalmoscopically, the disc metastasis appeared as a diffuse enlargement of the optic disc in 26 eyes (84%) and as a distinct nodule in 5 (16%). There was an adjacent juxtapapillary choroidal component to the metastatic disc lesion in 23 eyes (74%), and the optic disc was involved without a retinal or choroidal component in 8 (26%). Other associated findings included some degree of secondary disc edema in all eyes, buried disc blood vessels in 23 (74%), and splinter hemorrhages in 13 (42%). Fine needle aspiration biopsy was useful in establishing the diagnosis in all 5 eyes in which it was performed. Mean survival was 13 months after diagnosis of the disc metastasis.
Conclusions:
Metastasis to the optic disc accounts for 5% of all intraocular metastases. It can occur as invasion from a juxtapapillary choroidal metastasis or as isolated optic disc metastasis. Breast and lung cancers are the most common primary neoplasms that account for metastasis to the optic disc. The primary site is never determined in 20% of patients. The characteristic clinical features of optic disc metastasis should help differentiate it from other causes of swollen optic disc. Patient prognosis is poor.
Insights
Optic disc metastasis, rare in intraocular cancers, typically originates from breast or lung tumors. This study details its clinical features and poor prognosis, aiding in diagnosis and patient management.
Area of Science:
- Ophthalmology
- Oncology
- Medical Imaging
Background:
- Metastatic tumors to the optic disc are infrequently documented.
- Understanding their characteristics is crucial for diagnosis and treatment planning.
Purpose of the Study:
- To define the clinical presentation and outcomes for patients diagnosed with optic disc metastasis.
- To improve the diagnostic differentiation of optic disc metastasis from other optic neuropathies.
Main Methods:
- A retrospective analysis of patient charts was conducted.
- Data from 660 patients with intraocular metastasis were reviewed to identify cases of optic disc metastasis.
Main Results:
- Optic disc metastasis was identified in 30 patients (4.5% of intraocular metastases), predominantly women (80%).
- Breast (43%) and lung (27%) cancers were the most common primary sites; the primary origin remained undetermined in 20%.
- Clinical presentation included diffuse disc enlargement (84%), adjacent choroidal involvement (74%), secondary disc edema (100%), and a mean survival of 13 months.
Conclusions:
- Optic disc metastasis represents a small fraction of intraocular metastases, often presenting with distinct ophthalmoscopic features.
- Breast and lung cancers are the leading causes, though the primary tumor is frequently unknown.
- The prognosis for patients with optic disc metastasis is poor, highlighting the need for early recognition.
