Automated Perimetry and Laser Polarimetry in the Assessment of Nerve Fibers Involvement in Pituitary Adenoma

Abstract

Purpose: : To point out the nerve fibers involvement in patients suffering from pituitary adenomas submitted to transphenoidal surgery.

Methods: : 26 patients (50+/-17,9 ys) were selected and submitted to a complete ophthalmic examination before (baseline visit) and after surgery. The post-intervention examinations were scheduled at 1, 3, and 6 months. The adenomas were classified according to Hardy classification. A kinetic test (HFA-II, stimulus I/4) was performed as a screening and in case of abnormal outcomes a static test 24-2 or 30-2 was carried out to better determine the visual field (VF) defect. The retinal nerve fiber layer (RNFL) was evaluated by GDx-VCC.

Results: : 3 adenomas were classified as micro and 23 as macro: the dimensions and the extrasellar extension were very eterogeneous. At baseline visit, none patients suffering from microadenoma presented VF or RNFL damages: these data were confirmed at 1, 3, and 6 months examinations. Among the macroadenomas, at baseline, 16 subjects presented normal VF while 22 had normal GDx; 6 presented bitemporal hemianopia at VF, one of them bilateral and 2 of them had mono-lateral GDx alteration; a mono-lateral defect of VF was recorded in 3 patients, 2 of them had abnormal GDx. Six months later, 5 patients out of 6 with bilateral VF defect performed a normal VF examination, 2 and 1 of them presented abnormal GDx, bilateral and mono-lateral respectively.

Keywords: visual impairment: neuro-ophthalmological disease • imaging/image analysis: clinical • visual fields