First Author: M.Chakrabarti UK
Co Author(s): W. Andreatta R. Chavan S. Elsherbiny
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To report two patients presenting to our Ophthalmology Outpatient clinic with unilateral choroidal metastasis as a very rare manifestation of primary renal malignancy. One presented with the ocular metastases, as the initial presentation before being diagnosed with the primary renal tumour. The second had a total nephrectomy eighteen months prior to presenting with the choroidal metastases.
Outpatient clinic of two Ophthalmology Consultants in a tertiary level Ophthalmology hospital (Birmingham and Midlands eye centre, Birmingham, UK) with appropriate Radiology, Oncology and Ocular Oncology input.
The first patient, a sixty-five year old Caucasian male, under ophthalmic care for suspected glaucoma, presented with a three-week history of left eye blurred vision. On Ocular examination, there was a possible choroidal metastasis in the left eye with exudative retinal detachment. The second patient, a sixty-six year old Asian male presented with sudden decrease of right eye vision. Examination revealed right choroidal metastasis. Both the patients were duly referred to the local medical Oncology and Radiology teams for further opinion, advice and management, having deferred the option of intravitreal anti-VEGF therapy.
For the first patient, whole body CT imaging revealed a likely renal primary with hepatic and left ocular metastasis. The patient awaits an urgent renal biopsy for the histological diagnosis at present to decide further systemic management. The second patient had a confirmed diagnosis of clear cell renal carcinoma, Fuhrman grade 3 with bilateral pulmonary metastasis in 2015. His right choroidal deposits presented approximately 18 months later. He has been started on systemic Chemotherapy and remains under Oncology and Ophthalmology review.
Primary renal malignancy with ocular metastasis is uncommon and very scarcely reported. Renal malignancy presenting initially as choroidal metastasis is further rare. Our case series attempts to make ophthalmologists aware of the quite unusual and exceptional initial or late presentations of renal primary malignancy (in otherwise systemically asymptomatic patients) as secondary choroidal metastasis. This further helps to decide the appropriate referral, imaging, and ophthalmic management pathway for best patient care provision.