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Iris Metastasis From Systemic Cancer in 104 Patients

The 2014 Jerry A. Shields Lecture

Shields, Carol L. MD; Kaliki, Swathi MD; Crabtree, Gordon S. BA; Peshtani, Ani BS; Morton, Spenser BS; Anand, Ronan A. BA; Coco, Giulia MD; Shields, Jerry A. MD

doi: 10.1097/ICO.0000000000000285
Clinical Science
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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.

Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA. Dr Kaliki is now with the Ocular Oncology Service, L. V. Prasad Eye Institute, Hyderabad, India.

Reprints: Carol L. Shields, MD, Ocular Oncology Service, Suite 1440, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA 19107 (e-mail: carol.shields@shieldsoncology.com).

Supported by Eye Tumor Research Foundation, Philadelphia, PA (C.L.S.).

The authors have no funding or conflicts of interest to disclose.

Presented, in part, as the J. A. Shields Lecture at the Annual Meeting of the Asian Pacific Society of Ocular Oncology and Pathology; September 26, 2014; Hong Kong, China (C.L.S.), and at the American Academy of Ophthalmology Annual Meeting as a poster; October 17–21, 2014; Chicago, IL (C.L.S.).

The funders had no role in the design and conduct of the study, in the collection, analysis and interpretation of the data, and in the preparation, review or approval of the manuscript. C. L. Shields has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Received June 27, 2014

Received in revised form September 04, 2014

Accepted September 05, 2014

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