Korean Journal of Ophthalmology

The Korean Ophthalmological Society (대한안과학회)
권호 표지
DOI QR코드

DOI QR Code

Factors Influencing Visual Field Recovery after Transsphenoidal Resection of a Pituitary Adenoma

  • Lee, Dong Kyu (Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Sung, Mi Sun (Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Park, Sang Woo (Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School)
  • Received : 2017.07.24
  • Accepted : 2017.12.21
  • Published : 2018.12.05
⟨ Previous Next ⟩

Abstract

Purpose: This study aimed to analyze the factors influencing visual field recovery after transsphenoidal approach-tumor resection (TSA-TR) in pituitary adenoma patients with visual field defects (VFDs). Methods: We retrospectively evaluated 102 eyes of 102 patients with VFDs induced by pituitary adenomas who underwent TSA-TR between January 2010 and December 2015. All patients had been observed for more than one year. The severity of the VFD in each patient was evaluated using the mean deviation (MD) and pattern standard deviation in the most-affected eye. Clinical and demographic data such as preoperative visual acuity and visual field, age, sex, tumor volume, neurological symptoms at diagnosis, duration of symptoms, patterns of the preoperative VFD, and preoperative central VFD were investigated and analyzed for association with recovery of the visual field. Results: Recovery from VFDs occurred in 71 (69.6%) eyes after a mean period of $18.36{\pm}5.21$ months. The recovery group was younger (p = 0.003), had higher preoperative MD values (p = 0.016), and had better preoperative visual acuity (p = 0.03), compared with the non-recovery group. Preoperative central VFD (p = 0.006) and preoperative bilateral VFD (p = 0.016) were significantly less frequent in the recovery group. Multivariate logistic regression revealed that age at diagnosis (odds ratio [OR], 0.962; p = 0.022), preoperative MD (OR, 1.069; p = 0.046), preoperative central VFD (OR, 0.212; p = 0.039), and preoperative bilateral VFD (OR, 0.212; p = 0.035) were associated with visual field recovery after TSA-TR. Conclusions: Younger age, higher preoperative MD, and the preoperative abscence of central VFD or bilateral VFD were favorable factors influencing visual field recovery after TSA-TR in patients with pituitary adenomas. An understanding of the associated clinical factors may help predict visual outcomes after TSA-TR in pituitary adenoma patients with VFDs.

Keywords

References

  1. Kerrison JB, Lynn MJ, Baer CA, et al. Stages of improvement in visual fields after pituitary tumor resection. Am J Ophthalmol 2000;130:813-20. https://doi.org/10.1016/S0002-9394(00)00539-0
  2. Dekkers OM, Hammer S, de Keizer RJ, et al. The natural course of non-functioning pituitary macroadenomas. Eur J Endocrinol 2007;156:217-24. https://doi.org/10.1530/eje.1.02334
  3. Anderson D, Faber P, Marcovitz S, et al. Pituitary tumors and the ophthalmologist. Ophthalmology 1983;90:1265-70. https://doi.org/10.1016/S0161-6420(83)34393-1
  4. Hollenhorst RW, Younge BR. Ocular manifestations produced by adenomas of the pituitary gland: analysis of 1000 cases. In: Kohler PO, Ross GT, editors. Diagnosis and treatment of pituitary tumors. Amsterdam: Excerpta Medica; 1973. p. 53-64.
  5. Ebersold MJ, Quast LM, Laws ER Jr, et al. Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas. J Neurosurg 1986;64:713-9. https://doi.org/10.3171/jns.1986.64.5.0713
  6. Mortini P, Losa M, Barzaghi R, et al. Results of transsphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery 2005;56:1222-33. https://doi.org/10.1227/01.NEU.0000159647.64275.9D
  7. Yu FF, Chen LL, Su YH, et al. Factors influencing improvement of visual field after trans-sphenoidal resection of pituitary macroadenomas: a retrospective cohort study. Int J Ophthalmol 2015;8:1224-8.
  8. Ho RW, Huang HM, Ho JT. The influence of pituitary adenoma size on vision and visual outcomes after trans-sphenoidal adenectomy: a report of 78 cases. J Korean Neurosurg Soc 2015;57:23-31. https://doi.org/10.3340/jkns.2015.57.1.23
  9. Lee J, Kim SW, Kim DW, et al Predictive model for recovery of visual field after surgery of pituitary adenoma. J Neurooncol 2016;130:155-64. https://doi.org/10.1007/s11060-016-2227-5
  10. Peter M, De Tribolet N. Visual outcome after transsphenoidal surgery for pituitary adenomas. Br J Neurosurg 1995;9:151-7. https://doi.org/10.1080/02688699550041485
  11. Ogra S, Nichols AD, Stylli S, et al. Visual acuity and pattern of visual field loss at presentation in pituitary adenoma. J Clin Neurosci 2014;21:735-40. https://doi.org/10.1016/j.jocn.2014.01.005
  12. Sung MS, Heo H, Ji YS, Park SW. Predicting the risk of parafoveal scotoma in myopic normal tension glaucoma: role of optic disc tilt and rotation. Eye (Lond) 2017;31:1051-9. https://doi.org/10.1038/eye.2017.33
  13. Jesser J, Schlamp K, Bendszus M. Pituitary gland tumors. Radiologe 2014;54:981-8. https://doi.org/10.1007/s00117-014-2688-5
  14. Barzaghi LR, Medone M, Losa M, et al. Prognostic factors of visual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis by quantitative method. Neurosurg Rev 2012;35:369-78. https://doi.org/10.1007/s10143-011-0365-y
  15. Schmalisch K, Milian M, Schimitzek T, et al. Predictors for visual dysfunction in nonfunctioning pituitary adenomas: implications for neurosurgical management. Clin Endocrinol (Oxf) 2012;77:728-34. https://doi.org/10.1111/j.1365-2265.2012.04457.x
  16. Eda M, Saeki N, Fujimoto N, Sunami K. Demonstration of the optic pathway in large pituitary adenoma on heavily T2 weighted MR images. Br J Neurosurg 2002;16:21-9. https://doi.org/10.1080/02688690120114192

Cited by

  1. Ophthalmological Management of Patients with Pituitary Adenomas vol.237, pp.11, 2018, https://doi.org/10.1055/a-1291-9383
  2. Analysis of factors affecting visual field recovery following surgery for pituitary adenoma vol.41, pp.6, 2018, https://doi.org/10.1007/s10792-021-01757-6