Iris Metastasis From Systemic Cancer in 104 Patients: The 2014 Jerry A. Shields Lecture. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Shields, Carol L.; Kaliki, Swathi; Crabtree, Gordon S.; Peshtani, Ani; Morton, Spenser; Anand, Ronan A.; Coco, Giulia; Shields, Jerry A.
• Is Part Of: Cornea. Volume 34:Issue 1(2015)
• Publication Date: 2015-01
• Subjects: eye -- tumor -- iris -- metastasis -- cancer -- carcinoma; Cornea -- Periodicals; Cornea -- Periodicals; Cornée -- Périodiques; 617.719
• DOI: 10.1097/ICO.0000000000000285
• Languages: English
• ISSNs: 0277-3740

Abstract

Abstract : Purpose: To describe the clinical features, treatment, and outcome of patients with iris metastasis. Methods: Retrospective case series of 160 tumors in 107 eyes of 104 patients with iris metastasis from systemic cancer. Results: The median age at presentation with iris metastasis was 60 years. Iris metastasis was more common in whites (n = 93, 89%) and women (n = 65, 62%). The primary tumor was located in the breast (n = 34, 33%), lung (n = 28, 27%), skin (melanoma) (n = 13, 12%), kidney (n = 7, 7%), esophagus (n = 3, 3%), and others (n = 19, 19%). The main symptoms were pain (n = 33, 32%) or blurred vision (n = 31, 30%). The main findings were corectopia (n = 38, 37%) and secondary glaucoma (n = 38, 37%). The metastasis was unifocal (n = 84, 78%) or multifocal (n = 23, 21%) for a total of 160 tumors. The main tumor was centered at the iris root (n = 72, 69%), midzone (n = 22, 21%), or pupillary margin (n = 10, 10%), with median tumor diameter of 5 mm. Coexistent conjunctival or ciliary body/choroidal metastases were found in 39 patients. Management of iris metastasis included systemic chemotherapy (n = 18, 22%), external beam radiotherapy (n = 34, 41%), plaque radiotherapy (n = 20, 24%), surgical excision (n = 4, 5%), enucleation (n = 3, 4%), or observation (n = 4, 5%). Following treatment, tumor control without recurrence was achieved in 95% cases. In 98 cases with adequate follow-up information, death occurred in 85 (87%) at median 10 months (range, <1–239 months) from the date of iris metastasis. Conclusions: Metastatic tumors to the iris generally originate from primary malignancies in the breast, lung, or skin (melanoma). Despite successful ocular treatment, life prognosis is poor.