title: Iris metastasis from systemic cancer in 104 patients: the 2014 Jerry A. Shields Lecture.
abstract: OBJECTIVE
  To describe the clinical features, treatment, and outcome of patients with iris metastasis.
  
  
  METHODS
  Retrospective case series of 160 tumors in 107 eyes of 104 patients with iris metastasis from systemic cancer.
  
  
  RESULTS
  The median age at presentation with iris metastasis was 60 years. Iris metastasis was more common in whites (n = 93, 89%) and women (n = 65, 62%). The primary tumor was located in the breast (n = 34, 33%), lung (n = 28, 27%), skin (melanoma) (n = 13, 12%), kidney (n = 7, 7%), esophagus (n = 3, 3%), and others (n = 19, 19%). The main symptoms were pain (n = 33, 32%) or blurred vision (n = 31, 30%). The main findings were corectopia (n = 38, 37%) and secondary glaucoma (n = 38, 37%). The metastasis was unifocal (n = 84, 78%) or multifocal (n = 23, 21%) for a total of 160 tumors. The main tumor was centered at the iris root (n = 72, 69%), midzone (n = 22, 21%), or pupillary margin (n = 10, 10%), with median tumor diameter of 5 mm. Coexistent conjunctival or ciliary body/choroidal metastases were found in 39 patients. Management of iris metastasis included systemic chemotherapy (n = 18, 22%), external beam radiotherapy (n = 34, 41%), plaque radiotherapy (n = 20, 24%), surgical excision (n = 4, 5%), enucleation (n = 3, 4%), or observation (n = 4, 5%). Following treatment, tumor control without recurrence was achieved in 95% cases. In 98 cases with adequate follow-up information, death occurred in 85 (87%) at median 10 months (range, <1-239 months) from the date of iris metastasis.
  
  
  CONCLUSIONS
  Metastatic tumors to the iris generally originate from primary malignancies in the breast, lung, or skin (melanoma). Despite successful ocular treatment, life prognosis is poor.
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA. Dr Kaliki is now with the Ocular Oncology Service, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Swathi
authors.initials: S
authors.lastname: Kaliki
authors.forename: Gordon S
authors.initials: GS
authors.lastname: Crabtree
authors.forename: Ani
authors.initials: A
authors.lastname: Peshtani
authors.forename: Spenser
authors.initials: S
authors.lastname: Morton
authors.forename: Ronan A
authors.initials: RA
authors.lastname: Anand
authors.forename: Giulia
authors.initials: G
authors.lastname: Coco
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D058447:Eye Pain / Q000175:diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D015811:Iris Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D011878:Radiotherapy; D012189:Retrospective Studies; D012737:Sex Factors; D014786:Vision Disorders / Q000175:diagnosis; D014792:Visual Acuity; D044465:White People / Q000208:ethnology
chemical_list: D000970:Antineoplastic Agents