A 52-year-old male patient attended the emergency department with loss of vision in his right eye after a week's evolution. His past history included: right nephrectomy for renal carcinoma seven years earlier and right pneumonectomy for pulmonary metastasis three months earlier. At that time he was not receiving any treatment.
On ophthalmological examination his visual acuity was 0.1 in his right eye and unity in his left eye; the anterior pole and intraocular pressure were normal. Funduscopy of the right eye showed a uniform whitish choroidal mass at the level of the inferior temporal arcade of approximately four papillary diameters, with associated retinal detachment (RD) involving the macula, with no signs of intraocular inflammation. The left eye was normal. A B-mode ultrasound was performed showing a 3x6 mm cupuliform choroidal mass of medium-high reflectivity, without choroidal excavation. Angiography showed a mass with early hypofluorescence, late hyperfluorescence and a slightly mottled pattern.
Given the patient's history, the medical oncology department was consulted and performed the appropriate tests to rule out progression of the process. During this time the lesion and associated DR increased in size, affecting the macula. Initially, radiotherapy treatment was proposed to the patient, but he rejected it and opted for surgery. Enucleation was performed one month after diagnosis. Pathological examination confirmed the diagnosis of renal carcinoma metastasis, without extending beyond the choroid and without infiltrating the optic nerve. During one year of follow-up by the medical oncology department, no progression of the process was observed and the patient only received immunotherapy with interferon. One year after diagnosis of the choroidal metastasis, signs of progression have appeared and the patient has also received hormone therapy and chemotherapy, with no clear improvement.