The role of multimodal ophthalmic imaging in diagnosing choroidal metastasis

PURPOSE: To highlight the important role of multimodal ophthalmic imaging in establishing the diagnosis of choroidal metastasis.

METHOD: Case series of choroidal metastasis encountered in Universiti Malaya Medical Center between 2021 and 2023.

RESULTS: Three patients with known cases of primary cancer were presented with choroidal metastasis. Two patients reported blurred vision, with a visual acuity of hand movement, while one patient remained asymptomatic with a visual acuity of 6/6. Fundoscopic findings including subretinal mass and exudative retinal detachment. B-scan ultrasonographic findings including diffuse, plateau, heterogenous choroidal lesion and dome-shaped choroidal mass. Classical optical coherence tomography (OCT) feature is lumpy bumpy choroidal appearance with subretinal fluid. Fundus fluorescein angiography (FFA) generally showed early hypofluorescence followed by heterogenous leakage in the late. Indocyanine green angiography (ICGA) showed absence of choroidal vessels overlying the choroidal lesion.

CONCLUSION: From our case series, all patients with known case of primary cancer presented with choroidal metastasis, although rare, is the most common form of intraocular tumours. A detailed medical history, comprehensive clinical examination, and the use of multimodal ophthalmic imaging are essential for the accurate diagnosis of choroidal metastasis.