Optical Coherent Tomography Predicts Long-Term Visual Outcome of Pituitary Adenoma Surgery: New Perspectives From a 5-Year Follow-up Study.
Adenoma
/ complications
Adult
Female
Follow-Up Studies
Humans
Male
Middle Aged
Nerve Compression Syndromes
/ etiology
Neurosurgical Procedures
Pituitary Neoplasms
/ complications
Postoperative Period
Recovery of Function
/ physiology
Retina
/ diagnostic imaging
Retinal Neurons
/ pathology
Retrospective Studies
Tomography, Optical Coherence
/ methods
Vision Disorders
/ etiology
Optical coherence tomography
Pituitary adenoma
Retinal nerve fiber thickness
Transsphenoidal approach
Visual recovery
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
15 12 2020
15 12 2020
Historique:
received:
13
11
2019
accepted:
24
05
2020
pubmed:
1
8
2020
medline:
16
3
2021
entrez:
1
8
2020
Statut:
ppublish
Résumé
Compressive optic neuropathy is the most common indication for transsphenoidal surgery for pituitary adenomas. Optical coherence tomography (OCT) is a useful visual assessment tool for predicting postoperative visual field recovery. To analyze visual parameters and their association based on long-term follow-up. Only pituitary adenoma patients with abnormal visual field defects were selected. A total of 188 eyes from 113 patients assessed by visual field index (VFI) and 262 eyes from 155 patients assessed by mean deviation (MD) were enrolled in this study. Postoperative VFI, MD, and retinal nerve fiber layer (RNFL) thickness were evaluated and followed up. After classifying the patients into normal (>5%) and thin (<5%) RNFL groups, we investigated whether preoperative RNFL could predict visual field outcomes. We also observed how RNFL changes after surgery on a long-term basis. Both preoperative VFI and MD had a linear proportional relationship with preoperative RNFL thickness. Sustained improvement of the visual field was observed after surgery in both groups, and the degree of improvement over time in each group was similar. RNFL thickness continued to decrease until 36 mo after surgery (80.2 ± 13.3 μm to 66.6 ± 11.9 μm) while visual field continued to improve (VFI, 61.8 ± 24.5 to 84.3 ± 15.4; MD, -12.9 ± 7.3 dB to -6.3 ± 5.9 dB). Patients with thin preoperative RNFL may experience visual recovery similar to those with normal preoperative RNFL; however, the probability of normalized visual fields was not comparable. RNFL thickness showed a strong correlation with preoperative visual field defect. Long-term follow-up observation revealed a discrepancy between anatomic and functional recovery.
Sections du résumé
BACKGROUND
Compressive optic neuropathy is the most common indication for transsphenoidal surgery for pituitary adenomas. Optical coherence tomography (OCT) is a useful visual assessment tool for predicting postoperative visual field recovery.
OBJECTIVE
To analyze visual parameters and their association based on long-term follow-up.
METHODS
Only pituitary adenoma patients with abnormal visual field defects were selected. A total of 188 eyes from 113 patients assessed by visual field index (VFI) and 262 eyes from 155 patients assessed by mean deviation (MD) were enrolled in this study. Postoperative VFI, MD, and retinal nerve fiber layer (RNFL) thickness were evaluated and followed up. After classifying the patients into normal (>5%) and thin (<5%) RNFL groups, we investigated whether preoperative RNFL could predict visual field outcomes. We also observed how RNFL changes after surgery on a long-term basis.
RESULTS
Both preoperative VFI and MD had a linear proportional relationship with preoperative RNFL thickness. Sustained improvement of the visual field was observed after surgery in both groups, and the degree of improvement over time in each group was similar. RNFL thickness continued to decrease until 36 mo after surgery (80.2 ± 13.3 μm to 66.6 ± 11.9 μm) while visual field continued to improve (VFI, 61.8 ± 24.5 to 84.3 ± 15.4; MD, -12.9 ± 7.3 dB to -6.3 ± 5.9 dB).
CONCLUSION
Patients with thin preoperative RNFL may experience visual recovery similar to those with normal preoperative RNFL; however, the probability of normalized visual fields was not comparable. RNFL thickness showed a strong correlation with preoperative visual field defect. Long-term follow-up observation revealed a discrepancy between anatomic and functional recovery.
Identifiants
pubmed: 32735666
pii: 5879452
doi: 10.1093/neuros/nyaa318
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
106-112Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 by the Congress of Neurological Surgeons.