Intraocular metastases most commonly affect the uveal tract, with the choroid representing the predominant site. Although ocular involvement is uncommon relative to overall metastatic disease, uveal metastases are the most frequent intraocular malignancy in adults. Primary sources typically include breast and lung cancers, among other origins. Reported median survival after diagnosis of choroidal metastasis historically approximates 10–12 months for breast and lung primaries. This study aimed to characterize a consecutive single-center cohort of patients with choroidal metastases and to determine whether age at diagnosis and the primary tumor type serve as independent predictors of overall survival.
This retrospective analysis was performed at the Department of Ophthalmology and Optometry, Medical University of Vienna. Consecutive patients with clinically and/or imaging-diagnosed choroidal metastasis between August 2013 and October 2025 were eligible. The institutional ethics committee approved the study and waived written informed consent because of its retrospective design. Patient records were pseudonymized prior to analysis.
Inclusion required a diagnosis of choroidal metastasis and availability of clinical records and follow-up within the specified timeframe. Exclusion criteria included primary uveal melanoma, isolated iris or ciliary body metastasis, or absence of follow-up information. For bilateral cases, only right-eye data were used. Clinical evaluation included slit-lamp biomicroscopy and multimodal imaging at each visit. Collected variables comprised age, sex, primary tumor type and prior treatment, number of extraocular metastatic sites, tumor dimensions, and survival data. Dates of death and, where available, ICD-10 causes were obtained through the institutional death-data linkage service.
Imaging modalities included wide-field fundus photography, optical coherence tomography (OCT), fundus autofluorescence, B-scan ultrasonography, fluorescein and indocyanine green angiography, and OCT angiography when clinically indicated. Ultrasonographic tumor dimensions were measured using a 20-MHz probe. Transverse and longitudinal diameters and apical thickness were measured on representative still frames. Tumor volume was estimated with the ellipsoidal formula (π/6 × length × width × height).
Continuous variables were tested for normality using Kolmogorov-Smirnov. Depending on distribution, group comparisons used one-way ANOVA or Kruskal-Wallis testing. Overall survival was calculated from date of first choroidal metastasis diagnosis to death; patients alive at last follow-up were right-censored. For survival analyses, primary tumors were collapsed into three groups to maintain adequate sample sizes: Group 1, lung cancer (small- and non-small-cell); Group 2, breast cancer; Group 3, other primaries (including gastrointestinal, genitourinary, head and neck, endocrine, melanoma, and others). Age was dichotomized at the cohort median (59.6 years) for Kaplan-Meier analysis. Kaplan-Meier curves and log-rank testing compared survival distributions. Univariate and multivariate Cox proportional hazards models were used to identify independent predictors of overall survival. Statistical analyses were performed using SPSS version 29.0.
Seventy patients with choroidal metastasis met inclusion criteria. Median overall survival from diagnosis of choroidal metastasis for the cohort was 71.6 weeks. When stratified by age, patients younger than 59.6 years had significantly longer survival: median 88.3 weeks with an estimated 3-year survival of 33.2%. Patients aged 59.6 years or older had median survival of 41.9 weeks and an estimated 3-year survival of 16.8% (log-rank p = 0.037).
Survival by primary tumor group showed median values of 94.4 weeks for breast cancer (estimated 3-year survival 38.3%), 52.7 weeks for lung cancer (estimated 3-year survival 9.5%), and 40.6 weeks for other primaries (estimated 3-year survival 19.7%). Although numerically longer survival was observed for breast primaries, differences across the three primary tumor groups did not reach statistical significance (p = 0.269).
In multivariate Cox regression, age ≥59.6 years was independently associated with higher mortality (hazard ratio [HR] 2.10; p = 0.016). Having more than one extraocular metastatic site at presentation was also an independent predictor of increased mortality (HR 2.53; p = 0.029). The primary tumor grouping (lung, breast, other) was not identified as an independent predictor of survival in the multivariate model.
This single-center series indicates that age at diagnosis and the extent of systemic metastatic burden are stronger determinants of overall survival than the primary tumor category among patients presenting with choroidal metastases. Younger patients demonstrated a statistically significant survival advantage compared with older patients. Although breast cancer primaries showed the longest median survival numerically, the difference versus lung and other primaries was not statistically significant in this cohort.
The finding that more than one extraocular metastatic site independently predicts worse survival aligns with a clinical expectation that higher systemic tumor burden confers a poorer prognosis. These results emphasize the prognostic importance of comprehensive systemic staging and consideration of overall metastatic load when counseling patients with choroidal metastasis.
As a retrospective single-center study, this analysis is subject to the limitations inherent to chart review, including potential selection bias and variability in imaging and treatment approaches over time. Data sharing is restricted by ethical and legal limitations protecting patient privacy; however, anonymized data are available on reasonable request through the institutional ethics committee or the corresponding author as specified in the source article. The study period and grouping strategy were chosen to ensure adequate sample sizes but may limit granularity for less common primary tumor types.
In this cohort of 70 patients with choroidal metastasis, older age (≥59.6 years) and a higher number of extraocular metastatic sites at presentation independently predicted shorter overall survival. These factors appear to be more reliable prognostic indicators than the categorized primary tumor origin (lung, breast, other) in this dataset. The results support the importance of age and systemic metastatic burden in prognostic assessment and clinical counseling for patients with choroidal metastases.