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      Renal cell carcinoma choroidal metastasis recorded by smartphone with interface eyepiece adapter mounted on slit lamp : A case report

      case-report
      , MD a , , BD a , b , , MD, PhD a ,
      Medicine
      Lippincott Williams & Wilkins
      choroid, eyepiece adapter, metastasis, renal cell carcinoma, slit lamp, smartphone

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          Abstract

          Rationale:

          Ocular metastasis of renal cell carcinoma (RCC) is rare, and mainly located on the choroid. We report a choroidal metastasis from RCC, which was recorded by a smartphone with an interface eyepiece adapter mounted on a slit lamp.

          Patient concerns:

          A 45-year-old female presented with 1-month history of painless occlusion of the vision field on the left eye, who had undergone right nephrectomy for RCC 19 months ago.

          Diagnoses:

          A smooth, hemispherical and brown protrusion was found behind the pupil nasally. An enhanced computed tomography scan of the orbit showed a slightly high-density hemispherical nodule involving the nasal portions of the left eyeball, the enhancement of the lesion was obvious and homogeneous. A metastatic choroidal space-occupying lesion from RCC was highly suspected according to the clinical and radiological findings.

          Interventions:

          The patient was advised to undergo further treatment, such as radiotherapy.

          Outcomes:

          The images of choroid metastasis were recorded by the smartphone with the interface eyepiece adapter mounted on the slit lamp handily.

          Conclusions:

          The smartphone with an interface eyepiece adapter mounted on the slit lamp can be widely used to record the precious images in the clinic in a timely manner.

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          Most cited references13

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          Survey of 520 eyes with uveal metastases.

          The purpose of this investigation is to report the clinical features of patients with uveal metastases seen at a major ocular oncology center. A retrospective chart review was performed on all patients with uveal metastases evaluated at an ocular oncology outpatient facility over a 20-year period. To assess the systemic and ophthalmic features of uveal metastases. A total of 950 uveal metastases were diagnosed in 520 eyes of 420 consecutive patients. Of the 950 metastatic foci, the uveal involvement included iris in 90 (9%), ciliary body in 22 (2%), and choroid in 838 (88%). The total number of uveal metastases per eye was 1 (71%) in 370 eyes, 2 (12%) in 63 eyes, and 3 or more (17%) in 87 eyes. The mean number of uveal metastases per eye was two (median, one). Iris metastases presented most often as a yellow-to-white solitary nodule in the inferior quadrant. Ciliary body metastases typically presented as a solitary, sessile, or dome-shaped yellow mass in the inferior quadrant, but were difficult to visualize directly. The choroidal metastases typically were yellow in color, plateau shaped, and associated with subretinal fluid. In the 479 eyes with choroidal metastases, the epicenter of the main tumor was found in the macular area in 59 eyes (12%), between the macula and equator in 383 eyes (80%), and anterior to the equator in 37 eyes (8%). The mean size of the main (largest) choroidal tumor in each eye was 9 mm in base and 3 mm in thickness. At the time of ocular diagnosis, 278 patients (66%) reported a history of a primary cancer and 142 patients (34%) had no history of a cancer. Subsequent evaluation of these 142 patients after the ocular diagnosis of uveal metastasis showed a primary tumor in the lung in 50 patients (35%), breast in 10 (7%), others in 9 (6%), and no primary site was found in 73 patients (51%). Nearly half of the patients with no known primary site eventually died of diffuse metastatic disease. In the entire group of 420 patients, the uveal metastasis came from a primary cancer of the breast in 196 (47%), lung in 90 (21%), gastrointestinal tract in 18 (4%), kidney in 9 (2%), skin in 9 (2%), prostate in 9 (2%), and other cancers in 16 (4%). In 73 cases (17%), the primary site was never established despite systemic evaluation by medical oncologists. Iris, ciliary body, and choroidal metastases have typical clinical features that should suggest the diagnosis. The choroid is the most common site for uveal metastases, and the tumors occur most often in the posterior pole of the eye with an average of two tumors per eye. Approximately one third of patients have no history of primary cancer at the time of ocular diagnosis. Breast and lung cancers represent more than two thirds of the primary tumor sites.
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            Choroidal metastases: Origin, features, and therapy

            The choroid is the most common ocular site for metastatic disease, owing to abundant vascular supply. The primary cancers that most commonly lead to choroidal metastases include breast cancer (40-47%) and lung cancer (21-29%). Bilateral, multifocal metastases are most often secondary to breast cancer, whereas unilateral, unifocal metastasis are more commonly found with lung cancer. The treatment of choroidal metastasis depends on the systemic status of the patient and number, location, and laterality of the choroidal tumors. Treatment options include observation in patients with poor systemic status or those with resolved or asymptomatic disease; systemic chemotherapy, immunotherapy, hormone therapy, or whole eye radiotherapy if the metastases are active, multifocal and bilateral; plaque radiotherapy, transpupillary radiotherapy, or photodynamic therapy for active, solitary metastasis; and enucleation for those with blind painful eye. A database search was performed on PubMed, using the terms “choroidal metastasis,” or “choroidal metastases,” in combination with terms such as “treatment,” “features,” or “diagnosis.” Relevant articles were extracted and reviewed.
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              The Use of Smart phones in Ophthalmology

              Smart phones are being increasingly used among health professionals. Ophthalmological applications are widely available and can turn smart phones into sophisticated medical devices. Smart phones can be useful instruments for the practice of evidence-based medicine, professional education, mobile clinical communication, patient education, disease self-management, remote patient monitoring or as powerful administrative tools. Several applications are available for different ophthalmological examinations that can assess visual acuity, color vision, astigmatism, pupil size, Amsler grid test and more. Smart phones can be useful ophthalmic devices for taking images of anterior and posterior eye segment. Professional literature and educational material for patients are easily available with use of smart phones. Smart phones can store great amount of informations and are useful for long term monitoring with caution for patient confidentiality. The use of smart phones especially as diagnostic tools is not standardized and results should be carefully considered. Innovative role of smartphone technology and its use in research, education and information sharing makes smart phones a future of ophthalmology and medicine.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0025-7974
                1536-5964
                12 March 2021
                12 March 2021
                : 100
                : 10
                : e24910
                Affiliations
                [a ]Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital, Hangzhou Red-Cross Hospital
                [b ]The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
                Author notes
                []Correspondence: Shuang-qing Wu, Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital, Hangzhou Red-Cross Hospital, 208 Huancheng Road East, Hangzhou 310003, Zhejiang Province, PR China (e-mail: shuangqingwu@ 123456zju.edu.cn ).
                Article
                MD-D-20-11010 24910
                10.1097/MD.0000000000024910
                7969302
                33725849
                e40a85bd-6bb8-4868-93f9-b5547e9f390d
                Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 15 November 2020
                : 25 January 2021
                : 4 February 2021
                Categories
                5800
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                choroid,eyepiece adapter,metastasis,renal cell carcinoma,slit lamp,smartphone

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