Reversal of retinal ganglion cell dysfunction after surgical reduction of intraocular pressure.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Sehi, M; Grewal, DS; Goodkin, ML; Greenfield, DS

Published Date

  • December 2010

Published In

Volume / Issue

  • 117 / 12

Start / End Page

  • 2329 - 2336

PubMed ID

  • 20920827

Electronic International Standard Serial Number (EISSN)

  • 1549-4713

Digital Object Identifier (DOI)

  • 10.1016/j.ophtha.2010.08.049


  • eng

Conference Location

  • United States