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Cancers Affecting the Retina

by Sunir J. Garg, MD, FACS

Cancers affecting the retina usually begin in the choroid. Because the retina depends on the choroid for its support and half of its blood supply, damage to the choroid by a cancer is likely to affect vision.

Choroidal melanoma

Choroidal melanoma originates from choroidal melanocytes. Choroidal melanoma is the most common cancer originating in the eye, with an incidence of about 1 in 2500 whites. It is less common among darker-skinned people. It occurs most frequently at age 55 to 60. It may spread locally or metastasize and be fatal.

Symptoms tend to develop late and include loss of vision and symptoms of retinal detachment (see Retinal Detachment).

Diagnosis is by funduscopy, supplemented, when indicated, by other tests, such as ultrasonography, CT, fluorescein angiography, and serial photographs.

Small cancers are treated with laser, radiation, or radioactive implants, which may preserve vision and save the eye. Rarely, local resection is used. Large cancers may require enucleation.

Choroidal metastases

Choroidal metastases are common because the choroid is highly vascular. The most common primary cancers are those of the breast in women and of the lung and prostate in men.

Symptoms tend to develop late and include loss of vision and symptoms of retinal detachment.

Diagnosis is often incidental during routine ophthalmoscopy. Ultrasonography is usually done, and the diagnosis is confirmed using fine-needle biopsy.

Treatment depends on the primary cancer and usually involves systemic chemotherapy, radiation therapy, or both.

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