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Xie M, Wang XH, Yang JJ, Su ZX, Huang JH, Li PC, Jiang FG. Rapid progress of an iris metastasis from esophageal cancer: a case report and review of literature. Int J Ophthalmol 2024; 17:1557-1567. [PMID: 39156770 PMCID: PMC11286432 DOI: 10.18240/ijo.2024.08.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/04/2024] [Indexed: 08/20/2024] Open
Abstract
This case report details a rare instance of rapid iris metastasis from esophageal cancer in a 59-year-old man. A literature review was conducted to explore recent advances in detecting, diagnosing, and treating intraocular metastatic malignancies. Positron emission tomography-computed tomography played a crucial role in identifying primary sites and systemic metastases. Local treatment combined with systemic therapy effectively reduced tumor size, preserved useful vision, and improved the patient's survival rate. A comparison was made of the characteristics of iris metastases from esophageal cancer and lung cancer, including age, gender, tumor characteristics, and treatment. The challenges associated with diagnosis and treatment are discussed, highlighting the implications for clinical practice.
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Affiliation(s)
- Meng Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xing-Hua Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Jun-Jie Yang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Zi-Xuan Su
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Jia-Hui Huang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Peng-Cheng Li
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Fa-Gang Jiang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Babst N, Gniesmer S, Sonntag SR, Furashova O, Krestanova G, Heindl LM, Müller M, Grisanti S, Kakkassery V. [Clinical approach for solid intraocular metastases]. DIE OPHTHALMOLOGIE 2024; 121:352-365. [PMID: 38649497 DOI: 10.1007/s00347-024-02031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Intraocular metastases arising from solid tumors are found in approximately 2% of patients with metastatic tumor diseases and are therefore more frequent than originally assumed. They often affect the uvea and are associated with a poor prognosis. Due to the difficult diagnosis and an inconsistent treatment regimen, ophthalmologists have a special responsibility here. OBJECTIVE This article gives a summary of the various types of intraocular metastases with respect to clinical features, diagnostics, treatment and prognosis as well as recommendations for follow-up care. METHODS A selective literature search was carried out on the topic of intraocular metastases using PubMed and Google Scholar. RESULTS Intraocular metastases most frequently affect the uvea, specifically the choroid. In most cases the underlying disease is breast or lung cancer, but other rarer primary tumors have also been reported in the literature. Metastatic lesions can show very different morphological manifestations but can be distinguished based on the corresponding structure of manifestation in the eye and with the aid of targeted staging, thus providing valid information on the type of primary tumor. The treatment is partly experimental and usually depends on the primary tumor and leading symptoms of the patient. A differentiation between a curative or palliative treatment situation must always be made. CONCLUSION Intraocular metastases are the most frequent intraocular tumor and are usually associated with a poor prognosis. Accurate diagnostics for finding the treatment as well as interdisciplinary collaboration and the presentation of the patient on the tumor board are essential.
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Affiliation(s)
- Neele Babst
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - Stefanie Gniesmer
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Svenja Rebecca Sonntag
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Olga Furashova
- Klinik für Augenheilkunde, Klinikum Chemnitz, Chemnitz, Deutschland
| | | | - Ludwig Maximilian Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - Martin Müller
- Klinik für Hämatologie, Onkologie und Immunologie, Klinikum Region Hannover, Hannover, Deutschland
| | - Salvatore Grisanti
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Vinodh Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
- Klinik für Augenheilkunde, Klinikum Chemnitz, Chemnitz, Deutschland
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Markoulli M, Ahmad S, Arcot J, Arita R, Benitez-Del-Castillo J, Caffery B, Downie LE, Edwards K, Flanagan J, Labetoulle M, Misra SL, Mrugacz M, Singh S, Sheppard J, Vehof J, Versura P, Willcox MDP, Ziemanski J, Wolffsohn JS. TFOS Lifestyle: Impact of nutrition on the ocular surface. Ocul Surf 2023; 29:226-271. [PMID: 37100346 DOI: 10.1016/j.jtos.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
Abstract
Nutrients, required by human bodies to perform life-sustaining functions, are obtained from the diet. They are broadly classified into macronutrients (carbohydrates, lipids, and proteins), micronutrients (vitamins and minerals) and water. All nutrients serve as a source of energy, provide structural support to the body and/or regulate the chemical processes of the body. Food and drinks also consist of non-nutrients that may be beneficial (e.g., antioxidants) or harmful (e.g., dyes or preservatives added to processed foods) to the body and the ocular surface. There is also a complex interplay between systemic disorders and an individual's nutritional status. Changes in the gut microbiome may lead to alterations at the ocular surface. Poor nutrition may exacerbate select systemic conditions. Similarly, certain systemic conditions may affect the uptake, processing and distribution of nutrients by the body. These disorders may lead to deficiencies in micro- and macro-nutrients that are important in maintaining ocular surface health. Medications used to treat these conditions may also cause ocular surface changes. The prevalence of nutrition-related chronic diseases is climbing worldwide. This report sought to review the evidence supporting the impact of nutrition on the ocular surface, either directly or as a consequence of the chronic diseases that result. To address a key question, a systematic review investigated the effects of intentional food restriction on ocular surface health; of the 25 included studies, most investigated Ramadan fasting (56%), followed by bariatric surgery (16%), anorexia nervosa (16%), but none were judged to be of high quality, with no randomized-controlled trials.
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Affiliation(s)
- Maria Markoulli
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia.
| | - Sumayya Ahmad
- Icahn School of Medicine of Mt. Sinai, New York, NY, USA
| | - Jayashree Arcot
- Food and Health, School of Chemical Engineering, UNSW Sydney, Australia
| | - Reiko Arita
- Department of Ophthalmology, Itoh Clinic, Saitama, Japan
| | | | | | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Katie Edwards
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Judith Flanagan
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia; Vision CRC, USA
| | - Marc Labetoulle
- Ophthalmology Department, Hospital Bicêtre, APHP, Paris-Saclay University, Le Kremlin-Bicêtre, France; IDMIT (CEA-Paris Saclay-Inserm U1184), Fontenay-aux-Roses, France
| | - Stuti L Misra
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | | | - Sumeer Singh
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - John Sheppard
- Virginia Eye Consultants, Norfolk, VA, USA; Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jelle Vehof
- Departments of Ophthalmology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK; Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Piera Versura
- Cornea and Ocular Surface Analysis - Translation Research Laboratory, Ophthalmology Unit, DIMEC Alma Mater Studiorum Università di Bologna, Italy; IRCCS AOU di Bologna Policlinico di Sant'Orsola, Bologna, Italy
| | - Mark D P Willcox
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| | - Jillian Ziemanski
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James S Wolffsohn
- College of Health & Life Sciences, School of Optometry, Aston University, Birmingham, UK
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Liu W, Ma W, Guo R, Ji J. Snowflakes in the Eye - An Uncommon Presentation of Iris Metastasis of Esophageal Carcinoma and Review of Literature. Ocul Immunol Inflamm 2022; 30:1568-1571. [PMID: 34003704 DOI: 10.1080/09273948.2021.1906910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To alert clinicians to an uncommon presentation of iris metastasis of esophageal carcinoma. We reported a 67-year-old man complained of blurred vision and ocular pain of his right eye for 1 month. He was diagnosed iridocyclitis of the right eye 2 weeks ago and he had a history of esophageal squamous cell carcinoma for 5 years with no regular treatment. Under slit-lamp microscopy, accumulating snowflakes-like deposits were found in the anterior chamber of the right eye. Ocular metastasis was then confirmed by atypical cells in the aqueous humor and positron emission tomography (PET-CT). METHODS Retrospective review of a case note and review of literature. CONCLUSION We presented a rare case of iris metastasis of esophageal carcinoma and highlighted the importance of maintaining suspicion for metastasis in any elderly patients with uveitis, since the diseases masquerading as uveitis are not only vision threatening but may be potentially fatal.
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Affiliation(s)
- Wei Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Wenjiang Ma
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Ruru Guo
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Jian Ji
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Liu T, Bai F, Yang L, Liu L, Xiao J, Liu X. Primary Tumour Type, Clinical Features, Treatment and Outcome of Patients with Iris Metastasis. Ocul Immunol Inflamm 2022; 30:1726-1732. [PMID: 34228589 DOI: 10.1080/09273948.2021.1939392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To describe the primary tumour type, clinical features, treatment and outcome of patients with Iris metastasis. METHODS Retrospectively analyzed articles published from 1934 to 2019 in the PubMed database. RESULTS In total, 133 eyes of 125 patients with iris metastatic carcinoma were retrieved. The average age at metastasis diagnosis of the patients was 56 ± 15 years; 60 left eyes and 49 right eyes were involved. The most common primary tumors were lung carcinoma (42%) and breast carcinoma (15%). Approximately one-third of the patients were first diagnosed in the ophthalmology department before the primary tumor was detected. Twenty-two percent of iris metastases were discovered before and 33% were discovered after systemic metastasis. The most common complaints were blurred vision and pain. The clinical features included iris masses, neovascularization and keratic precipitates. 57 patients (64%, N = 90) had an elevated intraocular pressure. Local administration of radiation therapy or intraocular injections of anti-VEGF drugs relieved eye discomfort and controlled the high intraocular pressures. CONCLUSIONS Iris nodules with increased intraocular pressure and neovascularization may indicate iris metastasis. Lung cancer is the most common primary tumor.
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Affiliation(s)
- Tao Liu
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Feng Bai
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Li Yang
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Li Liu
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Jun Xiao
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Xiaoli Liu
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
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Mitamura M, Kase S, Suimon Y, Ito T, Ishida S. A Case of Metastatic Iris Tumor Observed With Anterior Segment Optical Coherence Tomography Before and After Radiation Therapy. In Vivo 2021; 34:2159-2162. [PMID: 32606198 DOI: 10.21873/invivo.12023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Metastatic iris tumors are relatively rare entities that are often treated with radiation therapy; however, it remains difficult to evaluate the effectiveness of treatment. Anterior segment optical coherence tomography (AS-OCT) provides high-resolution cross-sectional images with no dye injection, and may thus be useful for evaluating iris tumors. Herein, we report a case of metastatic iris tumor examined with AS-OCT before and after radiation therapy. CASE REPORT A 56-year-old Japanese woman complained of ocular hyperemia and pain in her right eye, and was referred to our hospital because of uveitis and an iris mass. One year before the initial visit, the patient was diagnosed with lung adenocarcinoma, and treated with chemotherapy. She also underwent radiation therapy 4 months ago due to multiple bone metastases. Slit-lamp microscopy revealed a 2×2 mm elevated lesion with partial depigmentation on the lower iris. AS-OCT examination revealed that the mass was located in the iris stroma with an irregular anterior surface. Based on fine needle aspiration cytology, she was diagnosed with metastatic iris tumor derived from lung adenocarcinoma, leading to local radiotherapy. Seven months later, AS-OCT showed shrinkage and atrophy of the iris tumor with peripheral anterior synechia formation. CONCLUSION We report a case of cytology-proven metastatic iris tumor observed with AS-OCT before and after radiation therapy. This study highlights the potential usefulness of AS-OCT for monitoring changes in tumor size and configuration following radiotherapy.
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Affiliation(s)
- Mizuho Mitamura
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuka Suimon
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takako Ito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Ozawa H, Usui Y, Takano Y, Horiuchi N, Kuribayashi T, Kurihara T, Smith LE, Tsubota K, Tomita Y. Iris metastasis as the initial presentation of metastatic esophageal cancer diagnosed by fine needle aspiration biopsy: A case report. Medicine (Baltimore) 2021; 100:e26232. [PMID: 34087906 PMCID: PMC8183745 DOI: 10.1097/md.0000000000026232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Metastasis of neoplasms to the eye is quite uncommon. In this case report, we describe a patient where primary esophageal cancer was diagnosed by fine needle aspiration biopsy (FNAB) of an iris tumor. PATIENT CONCERNS A 70-year-old male complained of redness and discomfort in the right eye. DIAGNOSIS AND INTERVENTIONS The patient's right eye was diagnosed as idiopathic uveitis, and a topical steroid was administered. As vitreous opacities were observed even after topical therapy, oral prednisolone was administered. On slit-lamp examination of the right eye, an iris mass with neovascularization was seen in the anterior chamber. A metastatic tumor was suspected, and FNAB was performed. Histology revealed squamous cell carcinoma. Systemic workup revealed esophageal cancer with several metastases. Best-corrected visual acuity decreased to 20/400, and intraocular pressure was 40 mmHg in the right eye. Two iris tumors with neovascularization were present extending into the anterior chamber with posterior iris synechiae and 360 degree peripheral anterior synechiae. Intraocular pressure in the right eye was medically managed with hypotensive eye drops and oral acetazolamide. Iris metastases were treated with 40 Gray of radiation therapy and concurrent chemotherapy. OUTCOMES The tumor regressed, but intraocular pressure was refractory to treatment because of 360 degree goniosynechial closure. The right eye lost light perception six months after treatment commenced, and the patient died 9 months after the onset of therapy due to multiple systemic metastases. LESSONS This is a rare case of masquerade syndrome without systemic symptoms in which FNAB of an iris tumor led to a diagnosis of metastatic esophageal squamous cell carcinoma. Although the patient lost his sight due to uncontrollable ocular hypertension, systemic chemotherapy, and radiation therapy were initially effective in the treatment of the metastatic iris tumor. As the prognosis of patients with metastatic iris tumors is poor, it is important for ophthalmologists to consider such diagnoses and conduct systemic investigations when necessary.
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Affiliation(s)
- Hiroko Ozawa
- Department of Ophthalmology, Kawasaki Municipal Hospital, Kanagawa
- Department of Ophthalmology, Keio University School of Medicine
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo
| | - Yoji Takano
- Department of Ophthalmology, Keio University School of Medicine
- Department of Ophthalmology, Kawasaki Municipal Ida Hospital
| | - Naoki Horiuchi
- Department of Ophthalmology, Keio University School of Medicine
| | - Tohru Kuribayashi
- Department of Radiation Oncology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | | | - Lois E.H. Smith
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Yohei Tomita
- Department of Ophthalmology, Keio University School of Medicine
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Siddiqui MAR, Hussain SZM, Mubarak M. Iris metastasis as the initial presentation of upper gastrointestinal tract carcinoma: a case report. J Med Case Rep 2019; 13:367. [PMID: 31831049 PMCID: PMC6909480 DOI: 10.1186/s13256-019-2303-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/24/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND We report a case of a patient with iris metastasis as the initial manifestation of a systemic cancer: upper gastrointestinal tract carcinoma. CASE PRESENTATION A 24-year-old Asian man presented to our hospital with complaints of red left eye, decreased visual acuity, pain, and photophobia for about 3 weeks with no prior history of cancer or any other medical abnormality. Ocular examination showed a pinkish white lesion on the superonasal part of the iris. The patient's intraocular pressure was progressively increasing despite medications, followed by lymphadenopathy 4 weeks later. Comprehensive examination was performed along with a complete systemic workup, which detected systemic malignancy. Histopathology and immunohistochemistry revealed signet ring cells, which indicated an upper gastrointestinal tract tumor as a primary source of iris metastasis. The systemic condition of the patient deteriorated rapidly thereafter and led to his death in the 12th week of the disease. CONCLUSION A red eye with iris lesions in otherwise healthy individuals should be considered as a possible initial manifestation of underlying systemic malignancy. Prompt referral of such patients to an oncologist is warranted.
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Affiliation(s)
- M A Rehman Siddiqui
- Section of Ophthalmology, Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan. .,Department of Ophthalmology, Shahzad Eye Hospital, Karachi, Pakistan. .,Department of Ophthalmology, South City Hospital, Karachi, Pakistan.
| | - Syed Zohaib Maroof Hussain
- Section of Ophthalmology, Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Muhammed Mubarak
- Javed I. Kazi Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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