{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:04:50Z","timestamp":1782846290764,"version":"3.54.5"},"reference-count":16,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Interact J Med Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Choroidal metastases (CM) represent a rare but clinically significant manifestation of systemic malignancy, most frequently from lung cancer.<\/jats:p>\n                  <jats:p>The choroid\u2019s vascular anatomy allows hematogenous tumor seeding. Although CM may be the first clinical sign of an underlying malignancy, evidence guiding its management in the modern immunotherapy era remains limited, as most published cases predate the widespread use of immune checkpoint-inhibitors.<\/jats:p>\n                  <jats:p>We describe a 33-year-old male patient presenting with ocular pain and visual disturbance, who was found to have an amelanotic choroidal lesion. Systemic workup revealed small pulmonary nodules and an iliac crest lesion. Sequential biopsies suggested that this was metastatic adenocarcinoma of unknown primary origin, but most likely of lung origin, without actionable mutations or PD-L1 (programmed death-ligand 1) expression. Management required multidisciplinary coordination and included carboplatin, paclitaxel, and pembrolizumab, followed by radiation to the orbit, iliac crest, and mediastinal sites of disease. Unfortunately, he experienced progression while on maintenance immunotherapy with new rib and brain lesions, for which he underwent treatment with platinum, pemetrexed, and bevacizumab with additional radiotherapy. Despite loss of vision in the affected eye, he achieved durable disease control and remains free of radiographic recurrent disease&gt;4 years after diagnosis.<\/jats:p>\n                  <jats:p>This case illustrates that multimodality salvage strategies\u2014integrating systemic therapy with aggressive local radiation\u2014can provide unexpectedly prolonged survival even after immunotherapy failure. Importantly, current guidelines offer minimal direction on managing CM in this context, and prior case reports do not reflect present-day treatment realities. The key message for clinicians is that CM should not automatically be approached with palliative intent; carefully selected patients may benefit from an oligometastatic strategy that actively targets limited metastatic sites to prolong survival. Our findings underscore the need for ophthalmology, radiation oncology, and medical oncology collaboration when vision-threatening or occult metastatic lesions arise.<\/jats:p>\n                  <jats:p>For readers, the takeaway is that choroidal metastasis\u2014particularly in the era of immunotherapy\u2014warrants individualized, multidisciplinary evaluation rather than default palliation. Our case demonstrates that coordinated multimodality management can achieve long-term disease control, highlighting a treatment paradigm worth considering for selected patients and calling for updated guidelines that reflect modern therapeutic capabilities.<\/jats:p>","DOI":"10.2196\/77895","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T16:25:09Z","timestamp":1767371109000},"page":"e77895-e77895","source":"Crossref","is-referenced-by-count":0,"title":["An Eye-Opening Approach: Cancer of Unknown Primary Source With Choroidal Metastasis Case Report"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9315-9613","authenticated-orcid":false,"given":"Erin","family":"Kaser","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7966-2247","authenticated-orcid":false,"given":"Vedin","family":"Barve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6365-1053","authenticated-orcid":false,"given":"Alexander","family":"Blaschke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8787-0487","authenticated-orcid":false,"given":"Constance","family":"Fry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4715-8801","authenticated-orcid":false,"given":"Corey","family":"Waldman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7449-6884","authenticated-orcid":false,"given":"Sarah","family":"Hackman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4491-3541","authenticated-orcid":false,"given":"William","family":"Kelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"issue":"21","key":"R1","doi-asserted-by":"publisher","first-page":"2586","DOI":"10.1097\/CM9.0000000000001015","article-title":"Blood-retinal barrier as a converging pivot in understanding the initiation and development of retinal diseases","volume":"133","author":"Yang","journal-title":"Chin Med J (Engl)"},{"issue":"4","key":"R2","doi-asserted-by":"publisher","first-page":"e397","DOI":"10.1016\/j.jcjo.2023.04.013","article-title":"Utility of systemic brigatinib therapy in tumour recurrence of choroid metastasis from non-small cell lung carcinoma","volume":"59","author":"Kim","journal-title":"Can J Ophthalmol"},{"issue":"5","key":"R3","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1038\/s41433-022-02015-4","article-title":"Metastatic tumours to the eye. 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