Mapping Sentinel Vessels in Uveal Melanomas Using Laser Speckle Contrast Imaging.

Introduction: Sentinel vessels provide an important early indication of underlying ocular neoplasm. To date, there is no noninvasive technique available for imaging and mapping of their vascular supply, which remains largely unstudied. We aimed to map sentinel vessels in uveal melanomas noninvasively by laser speckle contrast imaging (LSCI).

Case presentations: This report describes a case series of 4 patients undergoing enucleation due to uveal melanoma. Perfusion was imaged using LSCI during the successive detachment of the four rectus muscles, with their ciliary arteries, and the optic nerve with its ophthalmic artery. Tumor location and possible extrascleral growth were analyzed histopathologically. Sentinel vessels in uveal melanoma could be visualized noninvasively using LSCI, appearing broader and tortuous compared to surrounding vessels. The perfusion in the sentinel vessels was 24-94% higher than in the episcleral vessels. The origin of the sentinel vessel could be determined by perfusion monitoring during the successive detachment of the rectus muscles and the optic nerve. In 3 patients, the sentinel vessel was supplied by the anterior ciliary arteries and in 1 patient by the ophthalmic artery. In one of the cases, the sentinel vessel was not visible upon visual inspection.

Conclusion: This is the first study of its kind demonstrating detailed mapping of sentinel vessels in uveal melanoma using LSCI. LSCI shows potential for the detection of sentinel vessels before they are visible in slit lamp examination. Vascular changes are a hallmark of tumor growth, and noninvasive imaging with LSCI may be a useful diagnostic tool for the detection of uveal melanoma.