title: Factors influencing improvement of visual field after trans-sphenoidal resection of pituitary macroadenomas: a retrospective cohort study.
abstract: OBJECTIVE
  To investigate the influencing factors of visual field improvement after trans-sphenoidal resection of pituitary macroadenomas.
  
  
  METHODS
  This retrospective cohort study included 201 patients (366 eyes) with visual field defect induced by pituitary macroadenomas. All of them were treated with trans-sphenoidal surgery. Ophthalmologic evaluation, best-corrected visual acuity (BCVA), and visual field examination were performed before and 3mo after surgery. BCVA, visual field defect index mean deviation (MD), duration of symptoms, age, sex, and volume of tumors were compared. Expression of vascular endothelial growth factor (VEGF) and Ki-67 of tumor tissue were detected by immunohistochemical technique.
  
  
  RESULTS
  The mean age of patients was 44.23±1.29y. Ninety-three patients were female and 108 were male. The mean tumor volume was 14.36±6.23 cm(3). The mean duration of preoperative symptoms was 11.50±0.88mo. Mean preoperative MD was -17.50±0.82 dB. Mean Preoperative visual acuity was 0.64±0.04. Postoperative visual field improved in 270 (73.77%) eyes, unchanged in 96 (26.23%) eyes. Multivariate logistic regression displayed that the factors independently influencing visual field improvement were young age (OR=1.71, 95%CI: 1.325-2.387, P=0.013), low preoperative MD absolute value (OR=1.277, 95%CI: 1.205-1.355, P<0.001), small volume of tumor (OR=1.458, 95%CI: 1.060-4.289, P<0.001), low expression of VEGF in tumor tissue (OR=1.554, 95%CI: 1.089-2.457, P=0.022), and low expression of Ki-67 in tumor tissue (OR=1.552, 95%CI: 1.161-2.847, P=0.026).
  
  
  CONCLUSIONS
  After pituitary macroadenomas trans-sphenoidal resection, the independent influencing factors of the visual fields recovery were low preoperative MD absolute value, young age, small volume of tumor, and expression levels of VEGF/ Ki-67.
authors.affiliation: Department of Ophthalmology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
authors.forename: Fen-Fen
authors.initials: FF
authors.lastname: Yu
authors.affiliation: Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
authors.forename: Yi-Hua
authors.initials: YH
authors.lastname: Su
authors.affiliation: Department of Ophthalmology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
authors.forename: Li-Hun
authors.initials: LH
authors.lastname: Huo
authors.affiliation: Department of Ophthalmology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
authors.forename: Xian-Xuan
authors.initials: XX
authors.lastname: Lin
authors.affiliation: Department of Ophthalmology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
authors.forename: Rui-Duan
authors.initials: RD
authors.lastname: Liao
keywords: Ki-67; influencing factors; pituitary adenoma; vascular endothelial growth factor; visual field