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An audit of management of uveal metastases with special reference to early biopsy

Session Details

Session Title: Uveitis & Intraocular Tumours

Session Date/Time: Friday 27/09/2013 | 14:30-16:00

Paper Time: 15:50

Venue: Hall C (Level 1)

First Author: L.Konstantinidis UK

Co Author(s):    I. Rospond-Kubiak   I. Zeolite   H. Heimann   C. Groenewald     

Abstract Details

Purpose:

Uveal metastasis is the most common intraocular malignancy and it is often the first sign of tumour dissemination. The purpose of this study is to evaluate characteristics of uveal metastasis, treatment outcomes and assess the role of early biopsy in the management of these patients.

Setting:

Retrospective study of all patients with uveal metastases who were referred to the Liverpool Ocular Oncology Centre between January 2007 and December 2012.

Methods:

Biopsy was performed as a primary investigation if the clinical features suggested uveal metastasis and if there was no evidence of any extraocular metastases. The aims of the biopsy were, first, to confirm that the intraocular tumour was a metastasis and, second, to determine the most likely site of primary malignancy, if this was not known.

Results:

Ninety-six consecutive patients (109 eyes) with uveal metastasis were studied. The metastases involved the choroid in 97 eyes (89%), iris in 10 (9.2%) and the ciliary body (CB) in 3 eyes (2.8%). Breast carcinoma was the most common primary malignancy overall (41 patients; 42.7% and 75.5% of the 40 females in the sample). Lung carcinoma was the second most common primary malignancy overall (27 patients; 28.1%) and the most common primary malignancy in males (21 males; 48.8%). The median time interval between detection of primary cancer and uveal metastasis overall was 24 months (range, 1–288). Thirty-nine (40.6%) patients underwent ocular tumour biopsy, which confirmed the diagnosis in all patients and which identified the site of origin in 24 out of 27 patients in whom the primary tumour was unknown. In 7 of these cases, previous systemic investigations had failed to identify the primary tumour. The time from first assessment at our centre to histological diagnosis had a median of 5 days (range, 2 – 16). Seventy-three patients (76%) received external beam irradiation, 2 (2.1%) patients received PDT, 2 (2.1%) patients had Ru-106 plaque radiotherapy. The visual acuity was stable or improved in 75.5% of the cases.

Conclusions:

The results of this study support immediate biopsy, which provides a quick diagnosis, thereby expediting treatment. Early treatment of metastases should enhance any opportunities for conserving vision, especially as these tumours tend to grow rapidly.

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