Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany.
Retina. 2014 Jan;34(1):24-31. doi: 10.1097/IAE.0b013e3182947811.
To compare different quantification tools based on confocal scanning laser ophthalmoscopy for assessment of retinal pigment epithelium (RPE) tear area size.
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.
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.
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.
比较基于共焦激光扫描检眼镜的不同量化工具，以评估视网膜色素上皮 (RPE) 撕裂面积。
回顾性评估了 23 例因渗出性年龄相关性黄斑变性导致的色素上皮脱离而接受玻璃体内注射的患者的共焦激光扫描检眼镜眼底自发荧光 (FAF) 和近红外反射 (IR) 图像。基线时以及在 5.1±1.8 个月的随访后，另外评估了 11 例患者的图像。三位独立的读者使用三种方法测量 RPE 撕裂面积：手动在共焦激光扫描检眼镜 FAF 图像上测量、手动在共焦激光扫描检眼镜 IR 图像上测量以及使用基于 FAF 的半自动软件测量。
对于观察者内一致性（读者 1）和观察者间一致性（读者 1 和 2），FAF 的置信区间分别为 0.08 和 0.12，基于 FAF 的半自动软件分别为 0.11 和 0.09，IR 分别为 0.25 和 0.27。量化方法的平均平方误差值分别为 0.040±0.033 mm（FAF）、0.035±0.060 mm（软件）和 0.187±0.219 mm（IR）。基于 FAF 的半自动软件对所有 3 位读者的平均测量值作为 RPE 撕裂的基线平均面积为 5.77±4.62 mm（范围，0.13-14.74 mm）。单叶 RPE 撕裂（8 例）的随访测量结果显示病变面积无变化（0.14±0.33 mm）；相比之下，多叶 RPE 撕裂（3 例）的病变面积增大了 1.80±0.74 mm。
基于手动 FAF 和半自动 FAF 的 RPE 撕裂面积定量测量准确且可重复，优于手动 IR 测量。RPE 撕裂面积的定量测量与进一步的玻璃体内治疗具有临床相关性，特别是在多叶 RPE 撕裂中。
