Predictive factors for the development of visual loss in patients with pituitary macroadenomas and for visual recovery after optic pathway decompression.
OBJECTIVE
To investigate clinical and MRI findings that are predictive of both visual loss in patients with pituitary adenomas and visual recovery after treatment.


METHODS
Cohort study.


METHODS
Thirty patients (60 eyes) with pituitary adenoma.


METHODS
Patients underwent neuro-ophthalmic examination and MRI before and after optic chiasm decompression. Visual field (VF) was assessed using the mean deviation in standard automated perimetry (SAP) and temporal mean defect, the average of 22 temporal values of the total deviation plot. Tumour size was measured on sagittal and coronal cuts.


RESULTS
Visual loss was found in 47 eyes; 35 had optic atrophy (subtle in 9, moderate in 14, and severe in 12). Before treatment, the average SAP mean deviation and temporal mean defect were -11.78 (SD 8.56) dB and -18.66 (SD 11.20) dB, respectively. The chiasm was 17.3 (SD 6.2, range 10-34) mm above the reference line on the sagittal and 21.8 (SD 8.3, range 12-39) mm on the coronal images. Tumour size correlated with the severity of VF defect. VF improvement occurred in 80% of eyes after treatment. The degree of optic atrophy, visual loss, and tumour size were significantly associated with improvement after treatment.


CONCLUSIONS
The best predictive factor for visual loss was tumour size, and factors related to visual recovery were the degree of optic atrophy, the severity of VF defect, and the tumour size. Diagnosing pituitary adenomas before optic atrophy becomes severe may be related to a better prognosis in such patients.
Monteiro
Mário L R
ML
Department of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil. mlrmonteiro@terra.com.br
Zambon
Beatriz K
BK
Cunha
Leonardo P
LP
D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D005260:Female; D006423:Hemianopsia / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009896:Optic Atrophy / Q000175:diagnosis; D009897:Optic Chiasm / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D020127:Recovery of Function / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology; D055815:Young Adult