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Insights into Retinal Metastasis from Systemic Carcinoma: A Systematic Review of Clinical and Multimodal Imaging
Ling-Uei Wang1, Tzu-Han Hsieh1, Fang-Ting Chen1,2,3
1Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan.
Abstract:
Background/Objectives: Retinal metastasis (RM) is an exceptionally rare clinical condition, comprising less than 1% of ocular metastasis cases. This study aims to investigate the clinical features of RM originating from systemic carcinoma. Methods: A systematic review (PROSPERO ID: CRD42022344724). Results: The systematic review revealed 58 cases involving 61 eyes. Most of the cases (82.8%) had a known primary malignancy before RM was diagnosed. The main primary sites were the lung (45.8%), gastrointestinal tract (23.7%), and breast (16.9%). The lung was the most common (80.0%) carcinoma in cases with unknown primary sites. The median survival after RM diagnosis was 11 months. The main clinical patterns were patchy retinal infiltrates (35.7%), an elevated retinal mass (63.8%), and punctate retinal infiltrates (7.1%). Subretinal fluid, vitreous seeding, and choroidal invasion were noted in 57.4%, 41.0%, and 6.6% of eyes, respectively. Key multimodal imaging features were early hypofluorescence with mid-to-late hyperfluorescence on fluorescein angiography (84.6%) and hyper-reflectiveness on optical coherence tomography (70.8%). A final best-corrected visual acuity of ≤20/200 was noted in 66.7% of the eyes. Conclusions: Patchy retinal infiltrates, an elevated retinal mass, and punctate retinal infiltrates are the major clinical patterns of RM from systemic carcinoma. The primary carcinoma sites are the lung, gastrointestinal tract, and breast. Systemic and visual prognoses were unfavorable.
Insights
Retinal metastasis (RM), a rare condition, often presents with elevated retinal masses or infiltrates. Primary cancers, frequently from the lung, lead to poor visual outcomes.
Area of Science:
- Ophthalmology
- Oncology
- Medical Imaging
Background:
- Retinal metastasis (RM) is a rare condition, accounting for <1% of ocular metastases.
- Systemic carcinoma is the primary cause of RM.
Purpose of the Study:
- To investigate the clinical features of RM from systemic carcinoma.
- To identify common primary cancer sites and clinical presentations of RM.
Main Methods:
- Systematic review of 58 cases (61 eyes).
- Analysis of clinical patterns, primary sites, imaging features, and outcomes.
Main Results:
- Lung (45.8%), gastrointestinal (23.7%), and breast (16.9%) were common primary sites.
- Elevated retinal mass (63.8%) and patchy infiltrates (35.7%) were key patterns.
- Median survival was 11 months; 66.7% had vision ≤20/200.
Conclusions:
- RM commonly presents as elevated masses or infiltrates.
- Lung, GI, and breast cancers are frequent origins.
- Systemic and visual prognoses for RM are generally poor.
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