98th Annual Meeting DOG 2000

K 136

Iris metastases of breast carcinoma

R. Neitzke, A. Müller, C. W. Spraul

Purpose: Metastatic cancer to the iris is rare. We report a case of metastases to the iris and the chamber angle with breast carcinoma.

Method: A 60-year-old woman with a history of breast carcinoma (invasive intraductal mamma carcinoma G2 pT2 pN0 M0; stage IIA) presented 5 years after excision of the tumor with lesions of the iris. Besides slit lamp examination including gonioscopy we used ultrasound-biomicroscopy (UBM) and positron-emission-tomography (PET) for diagnosis.

Result: The iris metastasis exhibited on examination as multiple whitish and pink nodules on the lower half of the iris of the right eye. The nodules were located in the level of the iris. The main tumor mass (2 x 2.5 mm) was prominent, highly vascularized and located nasally. The patient was without any distress. This ocular metastasis was found by accident on routine ophthalmologic check up. Best corrected visual acuity for both eyes was 20/40, intraocular pressure in the right and left eye were 7 and 9 mmHg, respectively. The infiltration of the chamber angle over 2 hours was demonstrated by gonioscopy and UBM. UBM showed lobular masses with mid to low reflective spikes. The size of the tumor was measured by UBM as 2.5 x 3.2 mm. The borderline between tumor and normal tissue was uncertain. The glucose analogue 18F-2-fluoro-2-deoxy-D-glucose was used as a radiotracer for PET. Systemic evaluation using PET proved - besides the lesions of the iris - metastatic lesions in the liver, lung, bones, and lymph nodes as well. The iris metastasis displayed an elevated turnover of glucose as a typical sign for malignancy with the PET examination. Chemotherapy was performed.

Conclusions: Breast carcinoma rarely leads to iris metastasis. Positron-emission-tomography is a sensitive diagnostic tool to identify metastatic lesions and is helpful deciding further therapy. Options to handle single metastases are gamma therapy, argon laser, xenon lamp photocoagulation, and partial block excision. For systemic metastases chemotherapy and radiotherapy are the best choices.

Augenklinik, Universitätsklinikum Ulm, Prittwitzstraße 43, D-89075 Ulm/Donau