A 65-year-old white woman developed painless blurred vision in the left eye over 10 days. She gave a history of breast carcinoma (estrogen receptor-positive) diagnosed 5 years previously and treated with lumpectomy and radiotherapy. Lymph node sampling was positive, requiring the use of systemic chemotherapy and hormone therapy with anastrozole (aromatase inhibitor). Four years after diagnosis, lung metastases were discovered and treated with fulvestrant (antiestrogen) intramuscular hormone therapy.
On ocular examination, the best corrected visual acuity was 20/30 in the right eye and 20/80 in the left. Intraocular pressures were normal in both eyes. Fundus examination of the right eye was normal. In the left eye, fundus examination revealed an amelanotic choroidal lesion superior to the optic disc measuring 12 x 11 x 2.6 mm with overlying lipofuscin. A shallow serous retinal detachment extended underneath the foveola. Ultrasonography revealed an acoustically solid plateau-shaped mass on B scan with high internal reflectivity on A scan (Figure 1). These findings were consistent with choroidal metastasis from known breast carcinoma. This solitary ocular metastasis was treated with 4000 cGy of I125 plaque radiotherapy, delivered over a 4-day period. Following plaque radiotherapy, visual acuity was improved in the left eye to 20/30 with complete resolution of the subretinal fluid at the 4-month follow-up. The metastasis regressed to a flat scar of 1.8 mm with surrounding retinal pigment epithelial alterations (Figure 2).