Ocular Metastasis: Clinical Course and Survival Analysis of 569 Patients (727 Eyes) Over a 40-Year Interval (1979-2018).

Abstract

Objective: To report the clinical course of a large series of patients with intraocular and epibulbar metastases to the eye encountered over a 40-year interval and determine whether recent systemic treatments have improved patient survival following detection compared to earlier cases.

Design: Retrospective case series and trend study.

Subjects: 727 eyes of 569 patients diagnosed with metastasis to the eye(s).

Methods: Retrospective chart review and statistical analysis with SPSS (including descriptive statistics, cross-tabulations, statistical comparison of distributions, actuarial event rate curves using both Kaplan-Meier and life table methods, and comparison of survival curves using the log rank test).

Main outcome measures: Sex and age of patients, source cancer and metastatic history, symptoms, laterality and focality of eye metastases, ocular sites of involvement, largest basal diameter and thickness of metastases, ocular biopsies, systemic and ophthalmic treatment, symptomatic and tumor response to treatment, cause of death, and median, 5-year, 10-year, and comparative overall survival among various categorical subgroups.

Results: We identified dates of death for 98.1% of 569 patients. The median overall survival was 8.2 months, the 5-year overall survival was 8.2%, and the 10-year overall survival was 2.8%. Patients encountered in the second half of the study interval did not have significantly better survival compared to those in the first half. Breast cancer was the most common primary cancer. Lung cancer follows as the second most common primary, with affected patients having far worse survival outcomes. Treatment was administered in 435 worse or only affected eyes, and of the 313 of those for which we have follow-up visual acuity data, visual acuity improved or remained stable in 62.6%. Of the 286 of those for which we have a follow-up fundus examination, 85.7% demonstrated initial complete or partial regression. One hundred fifty-seven of 569 total patients (27.6%) ultimately had bilateral ocular involvement.

Conclusions: Survival for patients with cancer metastatic to the eye, which remains extremely poor, did not improve significantly from 1979 to 2018. Breast and lung cancer remain the predominant primary cancers and are followed by gastrointestinal, hematologic, and genitourinary cancers. Based on available but incomplete data, treatment improves or maintains vision and shrinks metastases in most patients.