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RE-PERG, a new procedure for electrophysiologic diagnosis of glaucoma that may improve PERG specificity

Authors Mavilio A, Sisto D, Ferreri P, Cardascia N, Alessio G

Received 19 September 2016

Accepted for publication 23 December 2016

Published 23 January 2017 Volume 2017:11 Pages 209—218


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Alberto Mavilio,1 Dario Sisto,2 Paolo Ferreri,2 Nicola Cardascia,2 Giovanni Alessio2

1Social Health District, Glaucoma Center, Azienda Sanitaria Locale, Brindisi, 2Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy

Purpose: A significant variability of the second harmonic (2ndH) phase of steady-state pattern electroretinogram (SS-PERG) in intrasession retest has been recently described in glaucoma patients (GP), which has not been found in healthy subjects. To evaluate the reliability of phase variability in retest (a procedure called RE-PERG or REPERG) in the presence of cataract, which is known to affect standard PERG, we tested this procedure in GP, normal controls (NC), and cataract patients (CP).
Methods: The procedure was performed on 50 GP, 35 NC, and 27 CP. All subjects were examined with RE-PERG and SS-PERG and also with spectral domain optical coherence tomography and standard automated perimetry. Standard deviation of phase and amplitude value of 2ndH were correlated by means of one-way analysis of variance and Pearson correlation, with the mean deviation and pattern standard deviation assessed by standard automated perimetry and retinal nerve fiber layer and the ganglion cell complex thickness assessed by spectral domain optical coherence tomography. Receiver operating characteristics were calculated in cohort populations with and without cataract.
Results: Standard deviation of phase of 2ndH was significantly higher in GP with respect to NC (P<0.001) and CP (P<0.001), and it correlated with retinal nerve fiber layer (r=-0.5, P<0.001) and ganglion cell complex (r=-0.6, P<0.001) defects in GP. Receiver operating characteristic evaluation showed higher specificity of RE-PERG (86.4%; area under the curve 0.93) with respect to SS-PERG (54.5%; area under the curve 0.68) in CP.
Conclusion: RE-PERG may improve the specificity of SS-PERG in clinical practice in the discrimination of GP.

Keywords: glaucoma, pattern electroretinogram, optical coherence tomography, ganglion cells, visual field

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