Case Of The Month | July 2026

Answer

The fundus photographs reveal the metastatic lesions. The autofluorescence images show mottled autofluorescence of the lesions and hyperautofluorescence associated with the subretinal fluid, which extends into the macula in the left eye.

The patient was treated with ribociclib (Kisqali), aCDK4/6 inhibitor used to treat hormone receptor (HR)-positive, HER2-negative breast cancer. Ribociclib inhibits cyclin-dependent kinases 4 and 6, proteins that promote cell division, and is administered in combination with hormonal therapy. Our patient also received anastrozole (Arimidex).

The response was dramatic, with marked regression of the choroidal tumors in both eyes. One year later, the visual acuity in the left eye had improved to 20/60.

Before the advent of modern targeted and immunologic therapies, the prognosis for patients with metastatic cancer to the eye was generally poor, with most surviving less than one year. Carcinoid tumors were a notable exception. As a result, ocular metastases were typically managed with external beam radiation therapy, a palliative treatment that often preserved useful vision for the remainder of the patient's life.

Today, many patients with metastatic breast cancer who are candidates for targeted systemic therapies have substantially better outcomes. These treatments frequently produce regression of choroidal metastases while simultaneously controlling systemic disease, reducing or eliminating the need for ocular radiation in many cases.