1Kroher G., 1Lohmann C. P., 2Knüchel R., 1Spiegel D.

1University Eye Hospital, 2Institute of Pathology, Josef Strauß Allee 11, 93042 Regensburg

Introduction: The breastcancer metastasis is the most common intraocular tumor in females. Most frequently the metastasis is located in the choroid, whereas metastasis in the iris is rare. Irismetastasis occurs mostly unilaterally and presents with secondary glaucoma in nearly one third of the cases.
Casereport: A 67-year old woman presented with the sudden onset of pain, redness and diminished vision in the right eye of 1 week duration. Intraocular pressure was 50mmHg on the right eye. History revealed metastatic breast cancer with metastasis to the bone and lung. On slitlamp examination atypical blood vessels and whitish plaque-like masses could be detected at several areas of the iris. The pupil was dilatated and fixed. Gonioscopic examination revealed a partially closed angle. An excision biopsy of the iris was performed and the histopathologic examination demonstrated diffused infiltration of metastatic poorly differentiated cancercells with estrogenreceptor positivity. Therefore, percutan radiotherapy was started. Despite of maximal antiglaucomatous therapy intraocular pressure was hardly to be regulated and and the patient had to undergo cyclophotocoagulation.
Conclusion: In this case, the uncommon diffused cancer infiltration of the iris probably combined with infiltration of the trabecular meshwork lead to severe secondary glaucoma, which was hardly controlled by medical antiglaucomatous treatment. If there is increased intraocular pressure with a history of metastatic mammacarcinom, the possibility of diffused metastatic infitlration of the iris must be kept in mind.

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