Korean J Ophthalmol.  2018 Dec;32(6):488-496. 10.3341/kjo.2017.0094.

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

• Lee DK
• Sung MS
• Park SW

• KMID: 2427964
• DOI: http://doi.org/10.3341/kjo.2017.0094

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 ± 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.

Keyword

Influencing factors; Pituitary neoplasms; Visual fields

MeSH Terms

Diagnosis
Humans
Logistic Models
Pituitary Neoplasms*
Retrospective Studies
Tumor Burden
Visual Acuity
Visual Fields*

Figure

• 

  Fig. 1 A 72-year-old man who was diagnosed with pituitary adenoma and underwent transsphenoidal surgery. (A) Central visual field defect is apparent in the preoperative visual field of the left eye (OS; mean deviation, −13.99 dB), (B) as is visual field defect of the opposite eye (mean deviation, −6.58 dB). (C,D) There was no visual field recovery in the postoperative visual field at 12 months after transsphenoidal surgery. OD = right eye.

• 

  Fig. 2 A 42-year-old woman who was diagnosed with pituitary adenoma and underwent transsphenoidal surgery. (A) There was no central visual field defect in the preoperative visual field of the left eye (OS; mean deviation, −8.00 dB). (B) There is a normal visual field in the opposite eye (mean deviation, −1.45 dB). (C,D) There is marked visual field recovery in the postoperative visual field of the OS at 12 months after transsphenoidal surgery. OD = right eye.

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