To evaluate the short-term changes in inner retinal function using the photopic negative response (PhNR) after intraocular pressure (IOP) reduction in glaucoma. METHODS. Forty-seven participants with glaucoma who were commencing a new or additional IOP-lowering therapy (treatment group) and 39 participants with stable glaucoma (control group) were recruited. IOP, visual field, retinal nerve fiber layer thickness, and electroretinograms (ERGs) were recorded at baseline and at a follow-up visit (3 ± 2 months). An optimized protocol developed for a portable ERG device was used to record the PhNR. The PhNR saturated amplitude (V max), V max ratio, semi-saturation constant (K), and slope of the Naka-Rushton function were analyzed. RESULTS. A significant percentage reduction in IOP was observed in the treatment group (28 ± 3%) compared to the control group (2 ± 3%; P < 0.0001). For PhNR V max , there was no significant interaction (F 1,83 = 2.099, P = 0.15), but there was a significant difference between the two time points (F 1,83 = 5.689, P = 0.019). Post hoc analysis showed a significant difference between baseline and 3 months in the treatment group (mean difference, 1.23 μV; 95% confidence interval [CI], 0.24-2.22) but not in the control group (0.30 μV; 95% CI, 0.78-1.38). K and slope were not significantly different in either group. Improvement beyond test-retest variability was seen in 17% of participants in the treatment group compared to 3% in the control group (P = 0.007, χ 2 test). CONCLUSIONS. The optimized protocol for measuring the PhNR detected short-term improvements in a proportion of participants following IOP reduction, although the majority showed no change.
O artigo reflete sobre os processos construtores de novas tecnologias advindas da dinâmica da produção de novos conhecimentos científicos, que envolvem demandas de mercado, associadas aos interesses industriais, ao consumo e às expectativas sociais diante das inovações tecnológicas, o que impõe à comunidade científica e acadêmica, novos desafios na elaboração de saberes, principalmente, naqueles apoiados na perspectiva da complexidade com a concorrência de múltiplas áreas e campos de conhecimento, incluindo enfaticamente o da biossegurança. Através dessa dinâmica analítica discute-se a essencialidade da biossegurança e sua interface com as inovações tecnológicas e a bioética que se estabelecem pelas vertentes da política em beneficio das ações preventivas, voltadas para promoção da qualidade de processos tecnológicos inovadores direcionados para a saúde.
Purpose: To evaluate the incidence of intraocular pressure (IOP) spikes within the first postoperative hours following trabeculectomy (TRAB) and to determine possible associated factors. Methods: An observational study was carried out. We enrolled consecutive patients undergoing standard TRAB with mitomycin C. They were examined twice within the first few postoperative hours (hours 1-2 and 4-6) and 3 times after TRAB (on days 1, 7, and 30). Demographic and ocular data were collected. Main outcome measurements were postoperative IOP values at each time point and the frequency of IOP spikes, defined as IOP ≥25 mm Hg. Results: A total of 40 eyes of 40 patients were included (mean age 59.62 ± 13.37 years). Although IOP was significantly reduced to 11.14 ± 7.99 mm Hg at hours 1-2 (p < 0.01) and to 11.52 ± 7.30 mm Hg at hours 4-6 (p < 0.01), IOP spikes were documented in 3 patients (7.5%). In the group of patients with IOP spikes, we noted that there was a high incidence of black patients and that the surgeries had been performed by fellow surgeons. Conclusion: Although the majority of the cases (92.5% of the patients) did not present IOP spikes, 7.5% of our patients presented the event. In selected cases, such as those with advanced disease, fixation threat, and of black race, IOP should be monitored during the first few postoperative hours for the identification and adequate management of potential IOP spikes, preventing undesirable outcomes.
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