J Neurol Surg B Skull Base 2016; 77 - FP-02-02
DOI: 10.1055/s-0036-1592443

Spectrum of Visual Deficits Associated with Pituitary Adenoma and Factors Determining Visual Outcome in More Than 2,000 Eyes

Sivashanmugam Dhandapani 1, Pinaki Dutta 2, Tenzin Gyurmey 1, Reema Bansal 3, Ashis Pathak 4, Ashutosh Rai 1, Anil Bhansali 2, Kanchan Kumar Mukherjee 1
  • 1Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
  • 2Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
  • 3Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
  • 4Department of Neurosurgery, Fortis Hospital, Mohali, Punjab, India

Objective: Reports on visual defects associated with pituitary adenomas and their outcome following surgery have been inconsistent. This was to study the spectrum of visual defects and factors determining their outcome in a large cohort of patients with pituitary adenomas.

Methods: One thousand patients with pituitary adenomas managed in our center over the past 11 years were included in the study. Visual acuity, visual field and optic fundus were studied and documented before surgery, immediate post-operatively and till 1 year following surgery. Appropriate statistical analyses were performed.

Results: At initial presentation, visual involvement was seen in 87.2% of patients. Absent perception of light was noted among 15% of eyes. Bitemporal hemianopia was the commonest (48%) manifestation, followed by blindness (9% right and 10% left). Ten percent of patients were not aware of their visual defects. One year after surgery, 93% patients having abnormal vision had improvement in visual acuity and field, whereas visual parameters were static in 5%. Visual deterioration occurred only in 1% of patients. Visual improvement had significant association with pre-operative visual acuity, but not with tumor size. Also recent deficits had earlier visual improvement. Moreover, 5% of those who did not even have perception of light at presentation experienced significant improvement in vision after surgery.

Conclusion: Postoperative visual outcome following surgery for pituitary adenoma appears to be proportional to the pre-operative visual acuity and not tumor size. Though shorter visual history was associated with earlier visual improvement, even patients who were totally blind showed significant improvement.