Department of Vitreoretinal Surgery, Center of Ophthalmology, University of Cologne, Cologne, Germany Correspondence to Dr med. Albert Caramoy, Department of Vitreoretinal Surgery, Center of Ophthalmology, University of Cologne, Kerpenerstr. 62, 50924 Cologne, Germany; acaramoy@yahoo.co.uk Accepted 10 June 2012 This paper is freely available online under the BMJ Journals unlocked scheme, see http:// bjo.bmj.com/site/about/ unlocked.xhtml Clinical science Fundus autoﬂuorescence and spectral-domain optical coherence tomography ﬁndings suggesting tissue remodelling in retinal pigment epithelium tear Albert Caramoy, Sascha Fauser, Bernd Kirchhof ABSTRACT Aim To study tissue remodelling and wound healing after retinal pigment epithelium (RPE) tears due to age-related macular degeneration. Methods Retrospective longitudinal study of 36 eyes (33 patients) with RPE tears. Imaging was performed using fundus autoﬂuorescence (FAF) (l¼488 nm) and spectral-domain optical coherence tomography (SD- OCT). Presence of intraretinal hyper-reﬂective dots in SD- OCT, which correlated with hyperﬂuorescent dots in FAF, indicating RPE migration was studied. Morphology of subretinal mass and RPE layer integrity in the RPE denuded area over time were examined. Results 7 of 36 eyes (19.4%) showed patchy or hazy hyperﬂuorescent areas in FAF, and the majority of eyes (83.3%) showed hyper-reﬂective dots, which possibly represent intraretinal RPE migration and hard exudates. Homogenous subretinal mass was encountered in about half of all cases. In one case (2.8%), the RPE layer proliferated and covered the defect. Conclusions SD-OCT and FAF showed a considerable amount of RPE proliferation, migration and repopulation. Intraretinal RPE migration did not form a functional RPE layer. A small defect might be repaired by cell proliferation. But this RPE proliferation is not sufﬁcient to cover large defects. INTRODUCTION One devastating complication of exudative age- related macular degeneration is a retinal pigment epithelium (RPE) tear. In an RPE tear, the pigment epithelium sheath becomes separated from the neurosensoric retina. Although photoreceptor cells are not able to function during this separation,1 they can survive up to 325 days after an RPE tear.2 This knowledge is essential for planning therapies such as macular translocation3 4 or autologous pigment epithelium and choroid transplantation.5 6 These therapies are successful only in some cases but carry a high risk. Therefore, it is crucial to select patients who probably would beneﬁt from surgery. Some case reports on RPE tears reported spon- taneous reattachments of the RPE using time- domain optical coherence tomography (OCT).7 8 In this study, we analyse the use of fundus auto- ﬂuorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT), which is supe- rior to time-domain OCT, to enhance the current knowledge on remodelling process in RPE tears. If it is possible to predict this process, surgery would not be necessary for certain patients. In this paper, we examined the wound healing process of RPE tears to better understand which patients would have the greatest chance for such a reattachment. PATIENTS AND METHODS A retrospective data analysis was conducted of patients at the University Eye Hospital of Cologne, Germany, from the year 2001 to 2011. Eighty-eight patients with RPE tears can be identiﬁed from this time period. Among these patients, 33 patients were included in the study; the rest of them not having FAF and SD-OCT images were excluded. In three patients (patients 1, 2 and 30) the acute event of RPE tear happened before the introduction of SD-OCT in our clinic in 2008 (approximately 1 year before); therefore, SD-OCT measurements were performed since 2008. Two eyes of two patients (patient 5 and the left eye of patient 9) were part of a microperimetric study reported before.5 Approval from the local ethic committee was sought and waived due to the retrospective nature of the study. Informed consent was obtained from each patient after explanation of the nature and possible consequences of the study. The study followed the tenets of the Declaration of Helsinki. Each patient underwent a routine ophthalmo- logical examination, including best corrected visual acuity using Snellen charts, biomicroscopy and ﬂuorescein and/or indocyanine green angiography. SD-OCT and FAF were performed at every visit. SD-OCT was carried out with a Spectralis HRA +OCT device (Heidelberg Engineering, Heidelberg, Germany) that was equipped with an eye-tracking system for the simultaneous acquisition of near- infrared reﬂectance (l¼815 nm) and SD-OCT images. This simultaneous SD-OCT imaging was carried out with an illumination wavelength of 870 nm and an acquisition speed of 40 000 A-scans per second. For each eye, a standard protocol of SD- OCT imaging was used; this comprised a star of 6 B-scans (angle between scans was 308) and a block containing 37 B-scans (2083158, distance between B-scans: 125 mm). For these purposes, 19 SD-OCT images were averaged to obtain the ﬁnal image. FAF was acquired using the same device (excita- tion at l¼488 nm, emission 500e700 nm). The ﬁeld of view size encompassed 3083308, with an image resolution of 7683768 pixels. Grading of RPE tear was performed using grading system as suggested by Sarraf et al.9 According to this grading system, RPE tears are graded based on the greatest length of defect (hypoﬂuorescent area in FAF) in the vector direction of the tear and foveal involvement. For this measurement, the FAF Br J Ophthalmol 2012;96:1211–1216. doi:10.1136/bjophthalmol-2012-301750 1211