Postoperative Visual Field Outcomes in Patients Showing Visual Field Defects due to Pituitary Adenoma

Chan Hee Moon; Sun Chul Hwang; Tae Kwann Park

doi:10.3341/jkos.2011.52.6.726

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Moon, Hwang, and Park: Postoperative Visual Field Outcomes in Patients Showing Visual Field Defects due to Pituitary Adenoma

Original Article

J Korean Ophthalmol Soc 2011;52(6):726-733.

Published online: 31 August 2011

DOI: https://doi.org/10.3341/jkos.2011.52.6.726

Postoperative Visual Field Outcomes in Patients Showing Visual Field Defects due to Pituitary Adenoma

Chan Hee Moon, MD¹, Sun Chul Hwang, MD², Tae Kwann Park, MD¹

¹Departments of Ophthalmology and Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

²College of Medicine, Soonchunhyang University, Bucheon, Korea

Address reprint requests to Tae Kwann Park, MD, Department of Ophthalmology, Soonchunhyang University Bucheon Hospital #1174 Jung 1-dong, Wonmi-gu, Bucheon 420-767, Korea Tel: 82-32-621-5053, Fax: 82-32-621-5435, E-mail: genophilus@hanmail.net

Received 15 July 2010 Revised 10 January 2011 Accepted 22 March 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate visual field (VF) changes in patients with pituitary adenoma after surgical treatment.

Methods

The present study retrospectively evaluated 96 eyes of 48 patients with pituitary adenoma who received surgical tumor removal between July 2001 and February 2010. Preoperative and postoperative clinical data including age, tumor volume, logMAR BCVA, surgical technique (transsphenoidal surgery and transcranial surgery), static perimetry scores (mean deviation [MD], pattern standard deviation [PSD], and visual field defect [VFD] scores) were reviewed.

Results

The MD (15.79%, p = 0.001) and PSD (3.98%, p = 0.003) improved postoperatively (mean postoperative fol-low-up period 1.85 months). Transsphenoidal surgery for tumor removal showed significant MD (26.99%, p = 0.000) and PSD (12.92%, p = 0.003) improvements. A multivariate regression analysis of the transsphenoidal surgery patient group revealed that the preoperative MD was related to the postoperative MD (Pearson = 0.762, p = 0.000), but negatively correlated to the amount of postoperative improvement in MD score (Pearson = −0.231, p = 0.046). Transcranial surgery did not significantly improve the MD (p = 0.419), PSD (p = 0.562), VFD score (p = 0.135), or logMAR BCVA (p = 0.708).

Conclusions

Visual filed defects in patients with pituitary adenoma improved after neurosurgical treatment. Better postoperative visual field outcomes were achieved in patients who had smaller preoperative visual field defects. Transsphenoidal surgery significantly improved the visual field defects and visual acuity in patients with non-functioning pituitary adenoma, compared to the transcranial surgery patients.

Keywords: Mean deviation, Pattern standard deviation, Pituitary adenoma, Transcranial surgery, Transsphenoidal surgery

References

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Figure 1.

Comparisons of preoperative and postoperative mean deviation. Mean deviations were improved in all patient group and statistically significant, except TCA group. TSA = transsphenoidal approach; TCA = transcranial approach. Better eye = better seeing eye; Worse eye = worse seeing eye. ^* p < 0.05; ^† p < 0.01; ^‡ p < 0.001.

Figure 2.

Comparisons of preoperative and postoperative pattern standard deviations. Pattern standard deviations were improved in all patient group and statistically significant in all patient, Lt. eye, TSA, Better eye group. TSA = transsphenoidal approach; TCA = transcranial approach. Better eye = better seeing eye; Worse eye = worse seeing eye. ^* p < 0.05; ^† p < 0.01.

Figure 3.

Comparisons of preoperative and postoperative mean deviation (MD) and pattern standard deviation (PSD) in all patients. Preoperative MD correlate with postoperative MD significantly (Pearson = 0.733, p = 0.000). Preoperative PSD correlate with postoperative PSD significantly (Pearson = 0.602, p = 0.000).

Figure 4.

Comparisons of preoperative mean deviation (MD) and postoperative relative changes of MD. (A) All patient group, (B) Transsphenoidal approach group, (C) Transcranial approach group. Relative change = (preoperative value – postoperative value) /preoperative value (% presentation). Preoperative MD has negative correlation with postoperative relative changes of MD and statistically significant in transsphenoidal approach group.

Table 1.

Visual field defect scores

Score
0	Normal	Normal visual field
1	Quadrantanopsia	Loss of vision in a quarter of the visual field
2	Hemianopsia	Loss of vision in half of the visual field
3	Three quadrantanopsia	Loss of vision in three quarters of the visual field or worse, including blind

Table 2.

Demographic characteristics of all patients

Variable	All patient	TSA	TCA	p-value
Number of patients (eyes)	48/96	38/76	10/20
Sex ratio (M/F)	0.45	0.40	0.66	0.348
Age (mean ± SD, yr)	45.06 ± 14.16	43.89 ± 14.30	49.50 ± 12.99	0.116
Follow up period (mean ± SD, mon) Tumor volume (mean ± SD, cm³)	1.85 ± 1.91 17.58 ± 25.19	1.86 ± 2.09 17.22 ± 27.88	1.82 ± 1.00 18.93 ± 10.07	0.929 0.789
Residual tumor score (mean ± SD)	1.64 ± 0.73	1.64 ± 0.74	1.55 ± 0.68	0.608

TSA = transsphenoidal approach; TCA = transcranial approach.

Table 3.

Comparisons of preoperative and postoperative visual field and logMAR visual acuity

Variable	All patients	Rt. eye	Lt. eye	p-value	TSA	TCA	p-value	Better eye	Worse eye	p-value
n	96	48	48		76	20		48	48
Mean deviation (mean ± SD)
Preop	−10.23 ± 9.79	−9.78 ± 9.83	−10.67 ± 9.85	0.251	−9.58 ± 9.90	−12.83 ± 9.15	0.246	−8.11 ± 8.32	−12.21 ± 10.68	^*0.039
Postop	−7.73 ± 9.30	−7.57 ± 9.15	−7.88 ± 9.53	0.902	−6.06 ± 8.18	−14.31 ± 10.72	^†††0.000	−5.69 ± 7.55	−9.39 ± 10.67	^*0.039
Changes	2.50 ± 6.99	2.21 ± 4.90	2.78 ± 8.57		3.51 ± 6.44	−1.78 ± 7.79		2.41 ± 5.06	2.81 ± 8.60
Relative^‡	15.79 ± 71.14	20.57 ± 39.84	11.22 ± 13.27	0.393	26.99 ± 41.12	−28.40 ± 29.57	^††0.002	22.09 ± 41.70	6.88 ± 13.54	0.300
p-value	^**0.001	^**0.004	^*0.029		^***0.000	0.419		^**0.002	^*0.028
Pattern standard deviation (mean ± SD)
Preop	7.00 ± 4.92	6.94 ± 4.94	7.06 ± 4.96	0.902	6.50 ± 4.95	8.99 ± 4.39	^†0.046	6.92 ± 5.12	7.08 ± 4.77	0.956
Postop	5.62 ± 4.75	6.10 ± 5.13	5.16 ± 4.35	0.067	4.86 ± 4.51	8.62 ± 4.55	^††0.002	5.46 ± 4.89	5.77 ± 4.65	0.770
Changes	−1.38 ± 4.31	−0.84 ± 4.58	−1.89 ± 4.02		−1.63 ± 4.61	−0.36 ± 2.72		−1.45 ± 4.23	−1.30 ± 4.44
Relative^‡	3.98 ± 85.60	−5.26 ± 104.64	−12.84 ± 62.07	0.369	12.92 ± 6.35	4.09 ± 30.51	0.995	12.02 ± 35.30	6.33 ± 17.19	0.299
p-value	^**0.003	0.216	^**0.002		^**0.003	0.562		^*0.022	0.050
Visual field defect area score (mean ± SD)
Preop	1.35 ± 1.20	1.23 ± 1.21	1.45 ± 1.20	0.067	1.24 ± 1.23	1.78 ± 0.97	0.092	1.21 ± 1.14	1.55 ± 1.26	0.237
Postop	1.04 ± 1.15	1.00 ± 1.15	1.08 ± 1.16	0.359	0.78 ± 1.01	2.05 ± 1.12	^†††0.000	0.93 ± 1.07	1.21 ± 1.24	0.268
Changes	−0.30 ± 0.81	−0.23 ± 0.79	−0.37 ± 0.84		−0.45 ± 0.77	0.26 ± 0.73		−0.27 ± 0.79	−0.34 ± 0.84
p-value	^***0.000	^*0.047	^**0.003		^***0.000	0.135		^*0.022	^**0.008
logMAR BCVA (mean ± SD)
Preop	0.34 ± 0.49	0.35 ± 0.56	0.33 ± 0.43	0.949	0.31 ± 0.46	0.45 ± 0.63	0.354	0.22 ± 0.37	0.48 ± 0.61	^*0.027
Postop	0.28 ± 0.48	0.30 ± 0.54	0.25 ± 0.41	0.877	0.22 ± 0.41	0.49 ± 0.66	^†0.03	0.18 ± 0.34	0.39 ± 0.62	0.072
Changes	−0.06 ± 0.41	−0.04 ± 0.41	−0.07 ± 0.41		−0.09 ± 0.38	0.04 ± 0.51		−0.03 ± 0.37	−0.08 ± 0.45
p-value	0.146	0.444	0.203		^*0.046	0.708		0.509	0.185

TSA = transsphenoidal approach; TCA = transcranial approach.

^* p< 0.05

^** p < 0.01

^*** p < 0.001. ^* Tested by Paired sample T-test.

^† p< 0.05

^†† p < 0.01

^††† p < 0.001. ^† Tested by Independent sample T-test.

^‡ Relative: relative change = (preoperative value – postoperative value)/preoperative value (% presentation).

Table 4.

Relationship between preoperative MD, PSD and visual outcomes

		MD.change	PSD.change	PostOp.MD	PostOp.PSD
All patient
PreOp.MD	Pearson	−0.129	^*0.267	^‡0.733	^‡-0.602
	p-value	0.217	0.009	0.000	0.000
PreOp.PSD	Pearson	0.073	^†0.273	^‡-0.356	^‡0.602
	p-value	0.482	0.008	0.000	0.000
Transsphenoidal approach
PreOp.MD	Pearson	^*-0.231	^*0.294	^‡0.762	^‡-0.589
	p-value	0.046	0.010	0.000	0.000
PreOp.PSD	Pearson	^‡0.316	^†0.298	^†-0.306	^‡0.529
	p-value	0.006	0.009	0.008	0.000
Transcranial approach
PreOp.MD	Pearson	−0.194	0.076	^†0.703	^†-0.628
	p-value	0.427	0.756	0.001	0.004
PreOp.PSD	Pearson	−0.028	0.147	^*-0.544	^‡0.816
	p-value	0.910	0.548	0.016	0.000

Preop MD = preoperative mean deviation; Preop PSD = preoperative pattern standard deviation; Postop MD = postoperative mean deviation; Postop PSD = preoperative pattern standard deviation; MD change = postoperative relative changes of mean deviation; PSD change = postoperative relative changes of pattern standard deviation.

^* p < 0.05

^† p < 0.01

^‡ p < 0.001.

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