title: Quantification of retinal pigment epithelium tear area in age-related macular degeneration.
abstract: OBJECTIVE
  To compare different quantification tools based on confocal scanning laser ophthalmoscopy for assessment of retinal pigment epithelium (RPE) tear area size.
  
  
  METHODS
  Confocal scanning laser ophthalmoscopy fundus autofluorescence (FAF) and near-infrared reflectance (IR) images were retrospectively evaluated in 23 patients with RPE tear after intravitreal injection for pigment epithelium detachment due to exudative age-related macular degeneration at baseline and additionally in 11 patients after 5.1 ± 1.8 months of follow-up. Retinal pigment epithelium tear area was measured by three independent readers using three methods: manually on confocal scanning laser ophthalmoscopy FAF images, manually on confocal scanning laser ophthalmoscopy IR images, and using an FAF-based semiautomated software.
  
  
  RESULTS
  Confidence intervals were 0.08 and 0.12 for FAF, 0.11 and 0.09 for FAF-based semiautomated software, and 0.25 and 0.27 for IR for intraobserver (Reader 1) and interobserver agreements (Readers 1 and 2), respectively. The average values of the square errors of the quantification methods were 0.040 ± 0.033 mm (FAF), 0.035 ± 0.060 mm (software), and 0.187 ± 0.219 mm (IR). Mean area of RPE tears at baseline given as the average measurement of all 3 readers using FAF-based semiautomated software was 5.77 ± 4.62 mm (range, 0.13-14.74 mm). Follow-up measurements of unilobular RPE tears (8 patients) showed no change in lesion area size (0.14 ± 0.33 mm); in contrast, multilobular RPE tears (3 patients) showed a progression in lesion area size of 1.80 ± 0.74 mm.
  
  
  CONCLUSIONS
  Manual FAF-based and semiautomated FAF-based quantifications of RPE tear area are accurate and reproducible and superior to manual IR-based measurement. Retinal pigment epithelium tear area quantification is clinically relevant regarding further intravitreal treatment, particularly in multilobular RPE tears.
authors.affiliation: Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany.
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Clemens
authors.forename: Florian
authors.initials: F
authors.lastname: Alten
authors.forename: Christine
authors.initials: C
authors.lastname: Baumgart
authors.forename: Peter
authors.initials: P
authors.lastname: Heiduschka
authors.forename: Nicole
authors.initials: N
authors.lastname: Eter
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D009887:Ophthalmoscopy; D012167:Retinal Perforations / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D057135:Wet Macular Degeneration / Q000150:complications / Q000175:diagnosis*