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Klinisches Vorgehen bei soliden intraokulären Metastasen

Clinical approach for solid intraocular metastases

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Zusammenfassung

Hintergrund

Intraokuläre Metastasen solider Tumoren finden sich bei ca. 2 % aller Patienten mit metastasierter Tumorerkrankung und sind damit häufiger als ursprünglich angenommen. Sie betreffen oft die Uvea und sind mit einer schlechten Prognose assoziiert. Aufgrund der erschwerten Diagnose und eines nicht einheitlichen Therapieregimes besteht hier eine besondere Verantwortung der Augenheilkunde.

Fragestellung/Ziel

Es wird eine Zusammenfassung der verschiedenen intraokulären Metastasen in Bezug auf Klinik, Diagnostik, Therapie und Prognose sowie Empfehlung der Nachsorge gegeben.

Methoden

Es erfolgte eine selektive Literaturrecherche zum Thema intraokuläre Metastasen mittels PubMed und Google Scholar.

Ergebnisse

Intraokuläre Metastasen betreffen am häufigsten die Uvea, genauer die Choroidea. Meist liegt ein Mamma- oder Lungenkarzinom zugrunde, aber auch andere, seltenere Primarien sind in der Literatur beschrieben. Die metastatischen Läsionen können sich sehr unterschiedlich darstellen, lassen sich aber durch die entsprechende Manifestationsstruktur am Auge und mithilfe eines zielgerichteten Stagings voneinander abgrenzen und können so gute Hinweise auf die Art des Primarius liefern. Die Therapie ist teils experimentell und richtet sich meist nach dem Primarius und führenden Symptomen der Patient:innen. Es muss immer zwischen einer kurativen und palliativen Therapiesituation unterschieden werden.

Schlussfolgerung

Intraokuläre Metastasen sind der häufigste intraokuläre Tumor und meist mit einer schlechten Prognose assoziiert. Eine genaue Diagnostik zur Therapiefindung genauso wie die interdisziplinäre Zusammenarbeit und die Vorstellung des/der Patient:in im Tumorboard sind essenziell.

Abstract

Background

Intraocular metastases arising from solid tumors are found in approximately 2% of patients with metastatic tumor diseases and are therefore more frequent than originally assumed. They often affect the uvea and are associated with a poor prognosis. Due to the difficult diagnosis and an inconsistent treatment regimen, ophthalmologists have a special responsibility here.

Objective

This article gives a summary of the various types of intraocular metastases with respect to clinical features, diagnostics, treatment and prognosis as well as recommendations for follow-up care.

Methods

A selective literature search was carried out on the topic of intraocular metastases using PubMed and Google Scholar.

Results

Intraocular metastases most frequently affect the uvea, specifically the choroid. In most cases the underlying disease is breast or lung cancer, but other rarer primary tumors have also been reported in the literature. Metastatic lesions can show very different morphological manifestations but can be distinguished based on the corresponding structure of manifestation in the eye and with the aid of targeted staging, thus providing valid information on the type of primary tumor. The treatment is partly experimental and usually depends on the primary tumor and leading symptoms of the patient. A differentiation between a curative or palliative treatment situation must always be made.

Conclusion

Intraocular metastases are the most frequent intraocular tumor and are usually associated with a poor prognosis. Accurate diagnostics for finding the treatment as well as interdisciplinary collaboration and the presentation of the patient on the tumor board are essential.

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Authors and Affiliations

  1. Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    Neele Babst, Stefanie Gniesmer, Svenja Rebecca Sonntag, Salvatore Grisanti & Vinodh Kakkassery

  2. Klinik für Augenheilkunde, Klinikum Chemnitz, Chemnitz, Deutschland

    Olga Furashova, Gabriele Krestanova & Vinodh Kakkassery

  3. Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Deutschland

    Ludwig Maximilian Heindl

  4. Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland

    Ludwig Maximilian Heindl

  5. Klinik für Hämatologie, Onkologie und Immunologie, Klinikum Region Hannover, Hannover, Deutschland

    Martin Müller

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N. Babst, S. Gniesmer, S.R. Sonntag, O. Furashova, G. Krestanova, L.M. Heindl, M. Müller, S. Grisanti und V. Kakkassery geben an, dass kein Interessenkonflikt besteht.

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Babst, N., Gniesmer, S., Sonntag, S.R. et al. Klinisches Vorgehen bei soliden intraokulären Metastasen. Ophthalmologie (2024). https://doi.org/10.1007/s00347-024-02031-7

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