title: The time course of visual field recovery following transphenoidal surgery for pituitary adenomas: predictive factors for a good outcome.
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.
authors.affiliation: Brindhaven, II Deena Close, Queens Drive, London W3 0HR, UK. kannagnana@doctors.org.uk
authors.forename: K K
authors.initials: KK
authors.lastname: Gnanalingham
authors.forename: S
authors.initials: S
authors.lastname: Bhattacharjee
authors.forename: R
authors.initials: R
authors.lastname: Pennington
authors.forename: J
authors.initials: J
authors.lastname: Ng
authors.forename: N
authors.initials: N
authors.lastname: Mendoza
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology*; D014794:Visual Fields
references.citation: J Neurosurg. 1977 Jun;46(6):717-22
references.pmid: 859014
references.citation: J Neurol Neurosurg Psychiatry. 1979 Nov;42(11):973-82
references.pmid: 501374
references.citation: Acta Neurochir (Wien). 1983;68(3-4):175-86
references.pmid: 6880874
references.citation: Am J Ophthalmol. 1983 Aug;96(2):200-8
references.pmid: 6881243
references.citation: J Neurosurg. 1983 Sep;59(3):395-401
references.pmid: 6886753
references.citation: J Neurosurg. 1965 Jan;22:47-52
references.pmid: 14286337
references.citation: Arch Ophthalmol. 1987 Oct;105(10):1355-7
references.pmid: 3662906
references.citation: Arch Ophthalmol. 1988 Sep;106(9):1252-4
references.pmid: 3046588
references.citation: Endocrinol Metab Clin North Am. 1992 Sep;21(3):669-92
references.pmid: 1521518
references.citation: Br J Neurosurg. 1995 Apr;9(2):151-7
references.pmid: 7632360
references.citation: Br J Neurosurg. 1995;9(3):367-73
references.pmid: 7546358
references.citation: Neurosurgery. 1985 Sep;17(3):446-52
references.pmid: 4047355