Abstract
Purpose :
To determine the prognostic value of preoperative visual field (VF) and optical coherence tomography (OCT) measurement in visual field outcomes of patients with parasellar tumor.
Methods :
In this retrospective longitudinal study, structural and functional parameters of the eyes of patients with parasellar tumor who underwent transsphenoidal approach were analyzed by using OCT and VF test before and after the surgery. VF parameters include foveal threshold (FT), mean deviation (MD), pattern standard deviation (PSD) and visual field index (VFI). Spectral domain OCT parameters were peripapillary retinal nerve fiber layer thickness (pRNFL) and macular ganglion cell-inner plexiform layer complex thickness (mGCIPL). The postoperative visual field change was classified into three groups: group A with normal VF preoperatively, group B with recovered VF impairment postoperatively, group C with unrecovered VF impairment postoperatively.
Results :
Seventy-six eyes of 38 patients were analysed (32 eyes in Group A, 28 eyes in Group B, 16 eyes in Group C). Mean age of the patients was 48.6 years and 44.7% of them were male. The sellar region tumors were pituitary adenoma (78.9%), craniopharyngioma (10.5%), meningioma (7.9%), and rathke’s cleft cyst (2.6%). Mean duration of symptom prior to surgery was 8.3 months and mean tumor volume was 11.95 cm3. Preoperative VFI of each group was 97.9 %, 67.8 %, 47.2 % and MD was 0.03 dB, -9.88 dB, -15.59 dB and FT was 37.25 dB, 27.93 dB, 25.06 dB, respectively. Preoperative average pRNFL was 95.16 μm, 87.11 μm, 98.63 μm and average mGCIPL was 80.84 μm, 74.21 μm, 64.38 μm and minimal mGCIPL was 77.13 μm, 66.57 μm, 54.38 μm, respectively. There was significant difference among the three groups in VFI, average mGCIPL, minimal mGCIPL, some sectors of mGCIPL (superior, superonasal, inferonasal, inferior). Preoperative ocular parameters (FT, VFI, MD, PSD, pRNFL and mGCIPL) were analyzed by univariate logistic regression analysis, and VFI and mGCIPL parameters were significantly associated with favorable VF outcome (p <0.05). Only minimum mGCIPL was significant by multivariate logistic regression analysis when age and sex were adjusted (p = 0.001).
Conclusions :
In patients with sellar region tumor, mGCIPL thickness showed stronger association with VF improvement after the surgery than other functional and structural parameters measured by VF test and OCT including pRNFL.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.