Bilateral mastectomy, choroidal mass: A curve ball
The present case has been reported in the Indian Journal of Ophthalmology.

An asymptomatic 44-year-old lady was referred for an amelanotic mass in her right eye (OD). Routine screening detected a superior visual field defect OD coincidentally. Medical history revealed bilateral mastectomy for breast cancer. On examination, visual acuity was 20/40 OD and 20/30 left eye (OS). Both eyes (OU) had normal intraocular pressure and clear vitreous.

Fundus examination revealed an orange-colored choroidal mass inferotemporal to fovea OD. B-scan ultrasonography disclosed a dense lesion. Intravenous fluorescein angiography (IVFA) showed early and late hyperfluorescence.

Indocyanine green angiography (ICG) showed early filling and late “washout.” Optical coherence tomography (OCT) confirmed lesion without subfoveal fluid.

(a) Fundoscopy showed an orange-colored mass of 4 mm diameter, inferior to the foveola. (b) B-scan ultrasonography revealed an acoustically dense mass with thickness of 2.45 mm. (c) IVFA and (d) ICG demonstrated intense intralesional vascularity and “washout” of dye was noted on ICG. (e) OCT of the foveola showed no subfoveal fluid and the mass was smooth and dome-shaped.

These findings suggested choroidal hemangioma instead of metastasis from breast cancer. The patient was managed conservatively with observation. Follow-up 5 months later showed stable findings.