Visual parameters in patients with pituitary adenoma before and after transsphenoidal surgery

Abstract

Eighty-two patients with pituitary adenoma who underwent transsphenoidal surgery were examined before and after surgery. Nineteen patients had a normal preoperative neuro-ophthalmological examination. All of these patients maintained normal visual parameters postoperatively. The remaining 63 patients had tumour-related loss of visual acuity, visual field, or both. These patients ranged in age from 18 to 78 years. Duration of symptoms ranged from one day to ten years, with a median of six months. Preoperative visual acuity was 6/12 or better in 72% of eyes, with 90% of patients having 6/12 or better in their better eye. Only 7% of eyes had a normal preoperative visual field. Both visual acuity and visual field improved postoperatively in the majority of eyes. In eyes that were examined within one week after surgery and subsequently, substantial improvement occurred within the first postoperative week, but further improvement continued over weeks to months postoperatively, with visual field taking longer to stabilise than visual acuity. Visual acuity at last examination was 6/12 or better in 87% of eyes, and visual field at last examination was normal in 50% of eyes. A total of 92% of patients had visual acuity of 6/12 or better in their better eye, and 62% of patients had a normal visual field in their better eye. Visual acuity at last examination was correlated with both age and preoperative visual acuity. Last visual field also was correlated with both age and preoperative visual field. Patients with preoperative optic atrophy had a poorer visual prognosis than did patients with normal fundi.

Follow-up and long-term outcome of nonfunctioning pituitary adenoma operated by transsphenoidal surgery with intraoperative high-field magnetic resonance imaging

“…Increase of VA was documented in all 44 patients with preoperative deficiencies. While recovery from optic nerve compression by sellar lesions is often seen within days after surgery and may continue over several months [20,57,85], no further improvement of VF or VA deficits was seen in the present study later than 1 year after surgery. The authors of a recent study [13] with focus on the early prognosis of vision were able to conclude that assessment of optic chiasm decompression by iMRI is a reliable method and that decompression of the optic pathways detected by iMRI correlates highly with prognosis of visual deficits after surgery.…”

Optical coherence tomography predicts visual outcome for pituitary tumors

“…Since then, investigators have attempted to identify pre-operative characteristics that may predict recovery. Variables such as age, duration of symptoms, tumour size and volume, pre-operative visual acuity (VA) or visual field (VF) loss, optic atrophy and pattern electroretinogram have been explored but none has been able to consistently predict visual recovery following surgery [3][4][5][6][7][8][9][10][11][12][13][14][15]. Such predictors of visual outcome would be helpful to allow counseling of patients in relation to their ultimate likely visual function as well as tailoring of management strategies regarding the timing of surgery.…”

Invited Commentary: Ganglion Cell Complex Measurement in Compressive Optic Neuropathy

“…The crucial predictor is the appearance of the optic discs. Recovery of function correlates with the amount of optic atrophy (1–4). This can be gauged so easily by fundus examination that I seldom bother with optical coherence tomography (OCT).…”