J Korean Ophthalmol Soc.  2011 Jun;52(6):726-733. 10.3341/jkos.2011.52.6.726.

Postoperative Visual Field Outcomes in Patients Showing Visual Field Defects due to Pituitary Adenoma

• Moon CH
• Hwang SC
• Park TK

• KMID: 2214646
• DOI: http://doi.org/10.3341/jkos.2011.52.6.726

Abstract

PURPOSE
To evaluate visual field (VF) changes in patients with pituitary adenoma after surgical treatment.
METHODS
The present study retrospectively evaluated 96 eyes of 48 patients with pituitary adenoma who received surgical tumor removal between July 2001 and February 2010. Preoperative and postoperative clinical data including age, tumor volume, logMAR BCVA, surgical technique (transsphenoidal surgery and transcranial surgery), static perimetry scores (mean deviation [MD], pattern standard deviation [PSD], and visual field defect [VFD] scores) were reviewed.
RESULTS
The MD (15.79%, p = 0.001) and PSD (3.98%, p = 0.003) improved postoperatively (mean postoperative follow-up period 1.85 months). Transsphenoidal surgery for tumor removal showed significant MD (26.99%, p = 0.000) and PSD (12.92%, p = 0.003) improvements. A multivariate regression analysis of the transsphenoidal surgery patient group revealed that the preoperative MD was related to the postoperative MD (Pearson = 0.762, p = 0.000), but negatively correlated to the amount of postoperative improvement in MD score (Pearson = -0.231, p = 0.046). Transcranial surgery did not significantly improve the MD (p = 0.419), PSD (p = 0.562), VFD score (p = 0.135), or logMAR BCVA (p = 0.708).
CONCLUSIONS
Visual filed defects in patients with pituitary adenoma improved after neurosurgical treatment. Better postoperative visual field outcomes were achieved in patients who had smaller preoperative visual field defects. Transsphenoidal surgery significantly improved the visual field defects and visual acuity in patients with non-functioning pituitary adenoma, compared to the transcranial surgery patients.

Keyword

Mean deviation; Pattern standard deviation; Pituitary adenoma; Transcranial surgery; Transsphenoidal surgery

MeSH Terms

Eye
Follow-Up Studies
Humans
Pituitary Neoplasms
Retrospective Studies
Tumor Burden
Visual Acuity
Visual Field Tests
Visual Fields

Figure

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  Figure 1. Comparisons of preoperative and postoperative mean deviation. Mean deviations were improved in all patient group and statistically significant, except TCA group. TSA = transsphenoidal approach; TCA = transcranial approach. Better eye = better seeing eye; Worse eye = worse seeing eye. * p < 0.05; † p < 0.01; ‡ p < 0.001.

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  Figure 2. Comparisons of preoperative and postoperative pattern standard deviations. Pattern standard deviations were improved in all patient group and statistically significant in all patient, Lt. eye, TSA, Better eye group. TSA = transsphenoidal approach; TCA = transcranial approach. Better eye = better seeing eye; Worse eye = worse seeing eye. * p < 0.05; † p < 0.01.

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  Figure 3. Comparisons of preoperative and postoperative mean deviation (MD) and pattern standard deviation (PSD) in all patients. Preoperative MD correlate with postoperative MD significantly (Pearson = 0.733, p = 0.000). Preoperative PSD correlate with postoperative PSD significantly (Pearson = 0.602, p = 0.000).

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  Figure 4. Comparisons of preoperative mean deviation (MD) and postoperative relative changes of MD. (A) All patient group, (B) Transsphenoidal approach group, (C) Transcranial approach group. Relative change = (preoperative value – postoperative value) /preoperative value (% presentation). Preoperative MD has negative correlation with postoperative relative changes of MD and statistically significant in transsphenoidal approach group.

Reference

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