Breast carcinoma metastatic to the choroid. Analysis of 67 patients

Two hundred fifty patients with breast carcinoma had ocular examinations between 1973 and 1980. One hundred fifty-two patients were referred because of ocular symptoms or signs, and 98 were asymptomatic. Of the symptomatic patients, 58 had choroidal metastases; nine of the asymptomatic patients with stage IV metastatic breast cancer had choroidal involvement (9.2%). For the 67 patients with metastases, the median age at ocular diagnosis was 51 years. The median interval from primary to choroidal metastases was three years. Survival after ocular diagnosis ranged from one week to four years, with a median of nine months. Among the 67 patients, choroidal tumor deposits occurred bilaterally in 27 patients (40.3%), in 18 right eyes (26.9%), and in 22 left eyes (32.8%). Irradiation led to stabilization or improvement in visual acuity in virtually all cases. Patients in whom acuity was not threatened were observed on medical therapy. Four of these patients eventually required irradiation for increasing disease. Choroidal metastases tended to follow pulmonary dissemination, and to occur with or before central nervous system disease. Choroidal metastases are a common, treatable event in breast carcinoma and may represent the smallest detectable clinical lesion.