The Pattern of Visual Impairment in Patients with Pituitary Adenoma

Wang, Hanbin; Sun, Wei; Fu, Zhuang; Si, Zhichao; Zhu, Yufang; Zhai, Guangju; Zhao, Guangyu; Xu, Shulan; Pang, Qi

doi:10.1177/147323000803600525

Cited by 29 publications

(22 citation statements)

References 12 publications

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“…Nasal sectors (2, 3) of GCIPL strongly correlated with average RNFL. Inferior and nasal sector of GCIPL (2,3,4) correlated maximum with respect to most sectors in RNFL in general. However, Mário Monteiro et al 13 in their study found significant correlation between the nasal, temporal and average macular (GCIPL) thickness with temporal sectors of RNFL (<0.01) in pituitary adenoma patients.…”

Section: Discussionmentioning

confidence: 88%

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Pituitary Adenoma- Visual Fields, Retinal Nerve Fibre Layer and Ganglion Cell-Inner Plexiform Layer Thickness Analysis- A Correlational Study

Shetty¹,

Paul²,

Ballal³

et al. 2017

jebmh

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BACKGROUNDPituitary adenoma is a benign and most common tumour of the pituitary gland. It is also the most common parachiasmal tumour and accounts for approximately 10-15% of primary intracranial neoplasms. It has an annual incidence rate of 0.8-8 per 1,00,000 population. Pituitary adenomas are classified as functional and non-functional based on their hormonal activity. Functional adenomas are usually detected earlier due to clinical manifestations produced by excess of hormones.The aim of the study is to analyse visual acuity, visual fields, RNFL thickness and GCIPL thickness on optical coherence tomography (OCT) and to find a correlation between these parameters and tumour volume in patients diagnosed with pituitary adenoma. MATERIALS AND METHODS48 patients diagnosed with pituitary adenoma confirmed by MRI scan underwent complete ophthalmic evaluation (visual acuity, slit-lamp examination, fundus evaluation), perimetry using 30-2 SITA FAST strategy, (Humphrey Field Analyzer; Carl-Zeiss Meditec, Dublin, CA), and OCT of disc (for retinal nerve fibre layer-RNFL thickness) and macula (for ganglion cell-inner plexiform layer (GCIPL) thickness) using Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA) at Bangalore West Lions Super Speciality Eye Hospital, between June 2014 to June 2016. Various parameters like Mean Deviation (MD), Pattern Standard Deviation (PSD) and RNFL and GCIPL thickness on OCT were analysed and correlated with each other. RESULTSMean tumour volume in patients was 12.26 ± 15.8 cm 3 . Most of the patients had visual acuity 6/18 or better. Bitemporal hemianopia was seen in only 5 (12.2%) patients. Superotemporal quadrantanopia, arcuate defects, tubular fields and homonymous hemianopia were the other field defects seen. Total and pattern deviation plot of visual fields correlated well with tumour volume and visual acuity. On visual field analysis, the MD (-8.18 ± 8.65 dB) was depressed compared to the control group (-2.0 ± 1.8 dB), and PSD value (5.76 ± 4.8 dB) was higher than controls (1.9 ± 1.0 dB). However, MD and PSD did not correlate well with tumour volumes. Mean RNFL thickness (85.9 ± 14.5 µm) and mean GCIPL thickness (71.6 ± 17.2 µm), values revealed global thinning in patients when compared with RNFL thickness (92.4 ±7.6 µm) and GCIPL thickness (80.4 ± 4.0 µm) in controls. MD and PSD correlated well with all sectors of RNFL and GCIPL (p value <0.01). CONCLUSIONPSD and GCIPL were concluded to be valuable tools in prognosis of the disease. Our study reinforces the effectiveness of investigations like standard automated perimetry and OCT in prognosticating the neurological disorder like pituitary adenoma and to understand the structural and functional relationship of the disease process. Our study recommends the use of GCIPL thickness evaluation by OCT for patients with unreliable fields or fields not corresponding to the disease progress.

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Section: Discussionmentioning

confidence: 88%

“…All values had p<0.05 and correlation coefficient of all these individual sectors and averages were depicted in Table 5 and (2, 3) of GCIPL strongly correlated with average RNFL (r=0.803). Inferior and nasal sector of GCIPL (2,3,4) correlated maximum with respect to most sectors in RNFL in general.…”

Section: Rnfl Thickness and Gcipl Thicknessmentioning

confidence: 88%

Pituitary Adenoma- Visual Fields, Retinal Nerve Fibre Layer and Ganglion Cell-Inner Plexiform Layer Thickness Analysis- A Correlational Study

Shetty¹,

Paul²,

Ballal³

et al. 2017

jebmh

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“…1 Almost a third of all pituitary adenomas present with vision deterioration. 2 Being the most crucial sign of a pituitary adenoma, early recognition of visual findings may help bring a successful outcome.…”

Section: Discussionmentioning

confidence: 99%

What Comes Down Must Go Up—Chiasmal Prolapse: A Field Report

Nair

Noronha

Moodambikana³

et al. 2011

Neuro-Ophthalmology

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We report a case of a 45-year-old man who had experienced considerable improvement in vision following surgery to excise a non-functioning pituitary adenoma. However, 1 year after surgery, during a regular followup, secondary visual field changes were detected that prompted neuroimaging. Magnetic resonance imaging revealed an empty sella with chiasmal prolapse, with no recurrence of the tumour. The patient underwent an endoscopic endonasal transsphenoidal chiasmapexy. Post-operatively the visual fields and the visual acuity showed improvement. This case emphasises the need for monitoring of visual fields, even post-operatively in cases of pituitary tumour. Chiasmal herniation can cause secondary visual field changes, early recognition of which can help in prompt surgical intervention to reverse the field loss.

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“…Decreases in visual acuity and visual field are thus the common presenting symptoms, caused by tumor pressure on the optic chiasm. 142 One study found visual defects occurring in over two-thirds of patients, with headaches occurring in an additional 41% of patients. 143 This same study found hypogonadism to be the most common clinical manifestation of hypopituitarism.…”

Section: Nonsecretory Adenomasmentioning

confidence: 98%

Pituitary Adenoma

Platta

MacKay²,

Welsh³

2010

American Journal of Clinical Oncology

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Pituitary adenomas comprise approximately 10% to 20% of all central nervous system neoplasms whereas autopsy series have suggested that the incidence of pituitary adenoma in the general population may approach 25%. Several treatment modalities are used in the treatment of pituitary adenomas, including observation, surgery, medical intervention, and radiotherapy. The treatment modality employed depends greatly on the type of pituitary adenoma and presenting symptoms. This review will discuss the biology of pituitary adenomas and the current management principles for the treatment of prolactinomas, Cushing disease, acromegaly, and nonsecretory adenomas, with an emphasis on the published radiotherapeutic literature.

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The Pattern of Visual Impairment in Patients with Pituitary Adenoma

Cited by 29 publications

References 12 publications

Pituitary Adenoma- Visual Fields, Retinal Nerve Fibre Layer and Ganglion Cell-Inner Plexiform Layer Thickness Analysis- A Correlational Study

Pituitary Adenoma- Visual Fields, Retinal Nerve Fibre Layer and Ganglion Cell-Inner Plexiform Layer Thickness Analysis- A Correlational Study

What Comes Down Must Go Up—Chiasmal Prolapse: A Field Report

Pituitary Adenoma

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