Abstract
Objective: To report the quantitative assessment of visual fields (VF) in patients with pituitary macroadenomas, and the time course and predictive factors for recovery of vision.
Methods: Retrospective study of 41 patients with pituitary adenomas and visual disturbance. Patients underwent pre- and postoperative VF assessment at one week, three to six months, one year, two years, and five years using the Humphrey field analyser, which gives a quantitative measure of VF in each quadrant.
Results: 36/41 patients (88%) presented with a visual disturbance. Mean (SEM) duration of symptoms was 94 (50) weeks (range 0.5 to 1500); 12 (29%) had optic atrophy at presentation. Impairment of VF was greatest in the upper temporal quadrant, followed by the lower temporal. VF recovery was progressive and apparent even at the five year follow up (p<0.001). Overall, VF returned to normal in 35% of eyes, improved in 60%, and remained unchanged in 5%. Patients whose VF returned to normal had a shorter duration of symptoms (16 (5) v 137 (56) weeks; p<0.05), better preoperative visual acuity (p<0.05), and a smaller degree of impairment in preoperative lateral quadrant VF (p<0.01) than those whose VF only improved. On multivariate analysis, the only predictive factor for VF recovery was the degree of impairment in VF preoperatively.
Conclusions: Transphenoidal surgery for pituitary macroadenoma results in a progressive recovery of VF in 95% of patients. The extent of the VF recovery is mainly dependent on the preoperative VF deficit, which emphasises the need for early intervention in these patients.
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Selected References
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- Ciric I., Mikhael M., Stafford T., Lawson L., Garces R. Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results. J Neurosurg. 1983 Sep;59(3):395–401. doi: 10.3171/jns.1983.59.3.0395. [DOI] [PubMed] [Google Scholar]
- Cohen A. R., Cooper P. R., Kupersmith M. J., Flamm E. S., Ransohoff J. Visual recovery after transsphenoidal removal of pituitary adenomas. Neurosurgery. 1985 Sep;17(3):446–452. doi: 10.1227/00006123-198509000-00008. [DOI] [PubMed] [Google Scholar]
- Enger C., Sommer A. Recognizing glaucomatous field loss with the Humphrey STATPAC. Arch Ophthalmol. 1987 Oct;105(10):1355–1357. doi: 10.1001/archopht.1987.01060100057024. [DOI] [PubMed] [Google Scholar]
- Fahlbusch R., Honegger J., Buchfelder M. Surgical management of acromegaly. Endocrinol Metab Clin North Am. 1992 Sep;21(3):669–692. [PubMed] [Google Scholar]
- Findlay G., McFadzean R. M., Teasdale G. Recovery of vision following treatment of pituitary tumours; application of a new system of assessment to patients treated by transsphenoidal operation. Acta Neurochir (Wien) 1983;68(3-4):175–186. doi: 10.1007/BF01401176. [DOI] [PubMed] [Google Scholar]
- Katz J., Sommer A. Reliability indexes of automated perimetric tests. Arch Ophthalmol. 1988 Sep;106(9):1252–1254. doi: 10.1001/archopht.1988.01060140412043. [DOI] [PubMed] [Google Scholar]
- Laws E. R., Jr, Trautmann J. C., Hollenhorst R. W., Jr Transsphenoidal decompression of the optic nerve and chiasm. Visual results in 62 patients. J Neurosurg. 1977 Jun;46(6):717–722. doi: 10.3171/jns.1977.46.6.0717. [DOI] [PubMed] [Google Scholar]
- Peter M., De Tribolet N. Visual outcome after transsphenoidal surgery for pituitary adenomas. Br J Neurosurg. 1995 Apr;9(2):151–157. doi: 10.1080/02688699550041485. [DOI] [PubMed] [Google Scholar]
- Powell M. Recovery of vision following transsphenoidal surgery for pituitary adenomas. Br J Neurosurg. 1995;9(3):367–373. doi: 10.1080/02688699550041377. [DOI] [PubMed] [Google Scholar]
- SVIEN H. J., LOVE J. G., KENNEDY W. C., COLBY M. Y., Jr, KEARNS T. P. STATUS OF VISION FOLLOWING SURGICAL TREATMENT FOR PITUITARY CHROMOPHOBE ADENOMA. J Neurosurg. 1965 Jan;22:47–52. doi: 10.3171/jns.1965.22.1.0047. [DOI] [PubMed] [Google Scholar]
- Symon L., Jakubowski J., Kendall B. Surgical treatment of giant pituitary adenomas. J Neurol Neurosurg Psychiatry. 1979 Nov;42(11):973–982. doi: 10.1136/jnnp.42.11.973. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Trautmann J. C., Laws E. R., Jr Visual status after transsphenoidal surgery at the Mayo Clinic, 1971-1982. Am J Ophthalmol. 1983 Aug;96(2):200–208. doi: 10.1016/s0002-9394(14)77788-8. [DOI] [PubMed] [Google Scholar]