Abstract

Choroidal metastasis is the most common intraocular metastatic manifestation of systemic malignancy and may present with serous or exudative retinal detachment. We report a 59-year-old man who presented with 1 week of reduced vision in the left eye associated with a left temporal hemifield defect. He had a history of IgA vasculitis treated with mycophenolate mofetil and hypertension. Bestcorrected visual acuity was 6/6 in the right eye and 6/12 in the left eye. Fundus examination of the left eye showed an exudative retinal detachment with yellowish choroidal masses involving the optic disc. Fluorescein angiography demonstrated early hypofluorescence with multiple pinpoint leaks, and B-scan ultrasonography showed a choroidal mass with medium internal reflectivity and no acoustic hollowing.
Systemic evaluation identified a right upper-lobe lung mass with extensive metastatic disease. Endobronchial ultrasound-guided transbronchial needle aspiration of a subcarinal node showed nonsmall- cell carcinoma with an immunoprofile favoring adenocarcinoma. The patient received imageguided radiotherapy to the whole brain and left posterior segment and systemic therapy with Osimertinib followed by pemetrexed and carboplatin. Subsequent imaging demonstrated regression of the choroidal lesion and marked resolution of the exudative retinal detachment, accompanied by systemic metabolic response on PET. This case highlights the importance of prompt systemic evaluation in patients presenting with an amelanotic choroidal mass and exudative retinal detachment.

Keywords:Choroidal metastasis; Exudative retinal detachment; Lung adenocarcinoma; Non-small-cell lung carcinoma; Radiotherapy and Osimertinib