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Al-Dahmash, Saad A. MD; Shields, Carol L. MD; Kaliki, Swathi MD; Johnson, Timothy MD; Shields, Jerry A. MD

doi: 10.1097/IAE.0000000000000131
Original Study

Purpose: To describe the imaging features of choroidal metastasis using enhanced depth imaging optical coherence tomography (EDI-OCT).

Methods: This retrospective observational case series included 31 eyes with choroidal metastasis. Spectral domain EDI-OCT was performed using Heidelberg Spectralis HRA + OCT. The main outcome measures were imaging features by EDI-OCT.

Results: Of 31 eyes with choroidal metastasis imaged with EDI-OCT, 14 (45%) eyes displayed image detail suitable for study. The metastasis originated from carcinoma of the breast (n = 7, 50%), lung (n = 5, 36%), pancreas (n = 1, 7%), and thyroid gland (n = 1, 7%). The mean tumor basal diameter was 6.4 mm, and mean thickness was 2.3 mm by B-scan ultrasonography. The tumor location was submacular in 6 (43%) eyes and extramacular in 8 (57%) eyes. By EDI-OCT, the mean tumor thickness was 987 μm. The most salient EDI-OCT features of the metastasis included anterior compression/obliteration of the overlying choriocapillaris (n = 13, 93%), an irregular (lumpy bumpy) anterior contour (n = 9, 64%), and posterior shadowing (n = 12, 86%). Overlying retinal pigment epithelial abnormalities were noted (n = 11, 78%). Outer retinal features included structural loss of the interdigitation of the cone outer segment tips (n = 9, 64%), the ellipsoid portion of photoreceptors (n = 8, 57%), external limiting membrane (n = 4, 29%), outer nuclear layer (n = 1, 7%), and outer plexiform layer (n = 1, 7%). The inner retinal layers (inner nuclear layer to nerve fiber layer) were normal. Subretinal fluid (n = 11, 79%), subretinal lipofuscin pigment (n = 1, 7%), and intraretinal edema (n = 2, 14%) were identified.

Conclusion: The EDI-OCT of choroidal metastasis shows a characteristic lumpy bumpy anterior tumor surface and outer retinal layer disruption with preservation of inner retinal layers.

Enhanced depth imaging optical coherence tomography of choroidal metastasis displayed “lumpy bumpy” anterior tumor surface (n = 9, 64%), choriocapillaris compression/obliteration (n = 13, 93%), outer retinal disruption (n = 11, 79%), and preservation of inner retinal layers (n = 14, 100%).

Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Al-Dahmash is now at the Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia; and Dr. Kaliki is now at the Ocular Oncology Service, L V Prasad Eye Institute, Hyderabad, India.

Reprint requests: Carol L. Shields, MD, Ocular Oncology Service, Suite 1440, Wills Eye Institute, Thomas Jefferson University, 840 Walnut Street, Philadelphia, PA 19107; e-mail:

None of the authors have any conflicting interests to disclose.

Supported by the Eye Tumor Research Foundation, Philadelphia, PA (C.L.S. and J.A.S.).

Carol 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.

© 2014 by Ophthalmic Communications Society, Inc.