Glaucoma-like optic neuropathy in patients with intracranial tumours

Abstract

ABSTRACT.Purpose: To examine frequency and associated factors of glaucoma-like appearance of the optic nerve head in patients with intrasellar, suprasellar or parasellar tumours. Methods: This retrospective clinical observational study included patients who were consecutively treated for intrasellar tumours (n = 143), suprasellar tumours (n = 321), parasellar tumours (n = 36) or retrosellar tumour (n = 1), and all of whom had undergone fundus photography and full-threshold visual field examination. The tumour spectrum included 336 pituitary gland tumours, 32 meningiomas, 89 craniopharyngiomas, 9 chiasmal gliomas and 35 other types of tumours or lesions. An age-matched control group was formed from the population-based Beijing Eye Study. Using fundus photographs and visual field examinations, glaucoma was defined by a neuroretinal rim shape not following the ISNT rule (Disc glaucoma group) and by an abnormal rim shape plus glaucoma-like visual field defects (Field glaucoma group). Type and size of the tumours were assessed on neuroradiological images. Results: Five-hundred and one patients fulfilled the inclusion criteria. Disc glaucoma and Field glaucoma were detected significantly more frequently in the study population [34 (6.8%) patients and 31 (6.3%) patients, respectively] than in the population-based control group of the same ethnicity (1.3% ± 0.5%; p < 0.001). In multivariate analysis, presence of Disc glaucoma [odds ratio (OR) = 2.64; p = 0.016] and presence of Field glaucoma (OR = 3.01; p = 0.027) were significantly associated with tumour location [suprasellar > parasellar > intrasellar]. The same held true for tumour width (OR = 1.08; p = 0.002; and OR = 1.08; p = 0.003, respectively). Conclusions: Large perisellar tumours were associated with a glaucoma-like appearance of the optic nerve head in eyes. It may diagnostically and pathogenetically be of importance.

Comparison of the Pattern of Retinal Ganglion Cell Damage Between Patients With Compressive and Glaucomatous Optic Neuropathies

“…[1][2][3] However, it is not uncommon for both characteristics to be combined: Glaucomatous optic discs sometimes accompany pale neuroretinal rim, 4,5 while some eyes with nonglaucomatous optic neuropathies show an enlarged optic cup. [6][7][8][9][10][11][12][13] The visual field defect respecting the vertical meridian is a characteristic feature of compressive optic neuropathy (CON), while glaucoma patients typically present with an arcuate scotoma. However, an arcuate scotoma can also be found in patient with CON 1,14,15 (which is sometimes due to patient error during the visual field testing).…”

Decision Making for Patients With Concomitant Pituitary Macroadenoma and Ophthalmologic Comorbidity: A Clinical Controversy

“…Other nonglaucomatous conditions also may produce disc cupping, including hereditary optic neuropathies, antecedent optic nerve infarction, trauma, methanol poisoning, infection, demyelinating optic neuritis, fusiform enlargement of the intracranial carotid artery, and intraorbital and intracranial mass lesions (12,22,25,28). The clinical differentiation of glaucomatous and nonglaucomatous disc cupping is often difficult (13).…”

Quantitative comparison of disc rim color in optic nerve atrophy of compressive optic neuropathy and glaucomatous optic neuropathy

“…On the other hand, in eyes with CON, the neuroretinal rim is relatively retained but develops pallor. However, some eyes with CON can also exhibit the same deepening of the optic cup that is seen in GON [12,13]. Thus, whether or not pallor is present at the neuroretinal rim is an important feature that differentiates CON from GON.…”