ORIGINAL ARTICLE
Year : 2019  |  Volume : 2 |  Issue : 2 |  Page : 28-29 |  DOI : https://doi.org/10.46319/RJMAHS.2019.v02i02.008

A rare case of unilateral carcinoma of breast manifesting as exudative retinal detachment - A case report

Supriya BN^1*, Lokesh HM^2
1 Junior resident, ² Professor, Department of Ophthalmology, Sri Siddhartha Medical College & Research Centre, SSAHE, Agalakote, Tumakuru

*Corresponding author:
Dr.Supriya B.N., Post graduate, Department of Ophthalmology, Sri Siddhartha Medical College,Tumkur
E-mail: supriyabnsupriya@gmail.com

Abstract
Exudative Retinal Detachment (ERD) secondary to metastasis is the diagnostic challenge for an ophthalmologist. It is characterized by the collection of sub-retinal fluid in the absence of retinal breaks or traction. One of the most important causes of ERD is the choroidal tumours such as melanomas, haemangiomas and metastases; hence it is very important to consider that ERD is caused by an intraocular tumour until proven otherwise. Among sites of metastasis in the eye choroid constitutes 81% of the cases followed by iris 9%.Choroidal metastasis is one of the causes for ERD, so thorough systemic workup required for further management. Here we describe a case of 38 year old female with ERD due to adenocarcinoma of the breast.

Keywords: Exudative retinal detachment, breast carcinoma, choroidal metastasis
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Introduction
Exudative Retinal Detachment (ERD) secondary to metastasis is the diagnostic challenge for an ophthalmologist.[1] It is characterized by accumulation of sub-retinal fluid in the absence of retinal breaks or traction.[2] Among malignant causes, the most common causes are metastasis of breast and lung carcinoma.[1] The incidence of ocular metastasis due to breast cancer varies among different studies, with rates between 5 and 30%.[3] Among site of metastasis in the eye choroid constitutes 81% of the cases followed by iris 9%.[1] The reason for increased metastatic dissemination to the choroid is its increased vascularity and microenvironmental factors which have been proposed as possible explanations.[4] In patients with diagnosed metastatic disease to the eye, the risk of another eye involvement is found to be 5% in a period of 10 months after diagnosis.[4] Treatment of ERD depends on the cause. Some cases resolve spontaneously, while few others are treated with systemic corticosteroids.[2]

Case report
A 38 year old female presented with sudden, painless loss of vision in the left eye of 3 days duration. She was a known case of adenocarcinoma of left breast and got operated for the same and has taken radiotherapy & chemotherapy 1 year back. On examination her visual acuity was counting fingers at 1 meter and 6/6 in left eye and right eye respectively and near vision was <N36 in left eye and N6 in the right eye. Pupils were round, regular and reactive in both the eyes. Cornea, anterior chamber, iris, lens were normal in both the eyes. Extraocular movements were full in all the gazes. On dilatation, Fundus showed partial ERD and sub-retinal mass in the left eye and right eye was within normal limits (Figure 1). B-Scan showed metastatic deposit with associated ERD in left eye (Figure 2).

Figure 1: Fundus picture of left eye showing partial ERD and Sub retinal mass

 
Figure 2: B Scan of left eye showing metastatic deposits with ERD

Discussion
Metastatic carcinomas are the most common intraocular tumors in the adults. Among metastatic ocular malignancies, breast and lung adenocarcinomas are the most common malignancies in women and men, respectively.[1] Usually breast malignancies are diagnosed before metastasis to the eye.
Demirci et al in their study reported that 264 cases with metastasis to uvea were secondary to breast malignancies.[5]
The most common cause for referring to the ophthalmologist was visual impairment (in about 93% of patients). In spite of multiple treatment modalities, the systemic prognosis was poor and one year survival rate was 62% and five year survival rate was 24% .[1] Till today, the treatment of choice for ocular metastasis is external beam radiotherapy. Chemotherapy also plays an important role in the control of uveal metastasis.[4]

Conclusion
As the choroidal metastases are one of the most common causes of ERD secondary to breast carcinoma, a thorough physical, systemic and oncology examination is required. In these patients, the collaboration of a physician and surgeon including an ophthalmologist is mandatory for diagnosis and proper treatment of ocular metastases and their by rescuing the patient's life.

Financial support and sponsorship: Nil
Conflict of interest: Nil

References
1. M. Mohammadpour, M. H. Dehghan and H. Ahmadieh. Bilateral exudative retinal detachment secondary to bilateral choroidal metastasis of bilateral breast carcinoma. ActaMedicaIranica. 2006; 44(3): 219-221.
2. Brad Bowling Kanski's clinical ophthalmology 8th edition; chapter 16:712.
3. K.M. Kreusel, T. Wiegel, M. Stange, N. Bornfeld, and M. H. Foerster, “Intraocular metastasis in metastatic female breast cancer. Incidence, risk factors and therapy” Ophthalmologe. 2000; 97(5):342-6.
4. Ilias Georgalas, Theodore Paraskevopoulos, Chryssanthi Koutsandrea etal. Ophthalmic Metastasis of Breast Cancer and Ocular Side Effects from Breast Cancer Treatment and Management: Mini Review. Hindawi Publishing Corporation BioMed Research International; Volume 2015, Article ID 57408.
5. Demirci H, Shields CL, Chao AN, Shields JA. Uveal metastasis from breast cancer in 264 patients. Am J Ophthalmol. 2003 Aug;136(2):264-71.