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Abstract #26997 Published in IGR 12-4
Reversal of retinal ganglion cell dysfunction after surgical reduction of intraocular pressure.
Sehi M; Grewal DS; Goodkin ML; Greenfield DSOphthalmology 2010; 117: 2329-2336
See also comment(s) by Michael Bach •
PURPOSE: The pattern electroretinogram optimized for glaucoma screening (PERGLA) is a noninvasive method of objectively measuring retinal ganglion cell (RGC) function. This study was undertaken to quantify the RGC response to intraocular pressure (IOP) reduction after glaucoma surgery. DESIGN: Prospective cohort study. PARTICIPANTS: Forty-seven eyes of 47 patients with uncontrolled IOP or progressive glaucomatous optic neuropathy receiving maximal medical therapy requiring trabeculectomy or aqueous drainage device implantation who met eligibility criteria. METHODS: Eyes with visual acuity less than 20/30, corneal or retinal pathologic features, or unreliable standard automated perimetry (SAP) results were excluded. All patients underwent complete ocular examination, arterial blood pressure, SAP, and PERGLA at 2 sessions before surgery and at 3 months after surgery. Mean ocular perfusion pressure (MOPP) was calculated. Each measure of PERGLA amplitude and phase was an average of 600 artifact-free signal registrations. MAIN OUTCOME MEASURES: Intraocular pressure and PERGLA amplitude and phase. RESULTS: Forty-seven eyes of 47 patients (mean age±standard deviation [SD], 69.9±11.3 years) were enrolled. Thirty-four eyes (72%) underwent trabeculectomy with antifibrosis therapy; 13 eyes (28%) underwent glaucoma drainage implant surgery. Mean±SD postoperative IOP (10.4±4.6 mmHg) was significantly (P<0.001) reduced compared with that before surgery (19.7±8.6 mmHg). Mean±SD postoperative PERGLA amplitude (0.46±0.22 μV) was significantly (P = 0.001) increased compared with preoperative PERGLA amplitude (0.37±0.18 μV). Mean±SD postoperative PERGLA phase (1.72±0.20 π-radian) was significantly (P = 0.01) reduced compared with preoperative PERGLA phase (1.81±0.22 π-radian). Mean±SD postoperative MOPP (53.1±6.4 mmHg) was significantly (P<0.001) increased compared with mean±SD preoperative MOPP (45.8±10.1 mmHg). No correlation (P>0.05) was identified between change in PERGLA amplitude and change in IOP or MOPP. CONCLUSIONS: Reversal of RGC dysfunction occurs after surgical reduction of IOP and may be quantified using PERGLA. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
Classification:
13.2.2.2 Improvement (Part of: 13 Therapeutic prognosis and outcome > 13.2 Outcome > 13.2.2 Visual field)
6.7 Electro-ophthalmodiagnosis (Part of: 6 Clinical examination methods)
