Abstract / Summary
Abstract Purpose To evaluate 3-month ophthalmologic outcomes after management of pituitary adenomas and identify clinical, radiological, surgical, and optical coherence tomography (OCT)-based predictors of visual-field recovery, with emphasis on functional status, transsphenoidal surgery (TSA), and a novel visual field-OCT discordance index (VFODI). Methods Seventy-five patients with pituitary adenoma/pituitary neuroendocrine tumor were retrospectively evaluated. Functional status, tumor size, optic chiasmal compression, TSA status, baseline visual-field mean deviation (MD), best-corrected visual acuity (BCVA), and OCT parameters were analyzed. VFODI was defined as the standardized residual reflecting visual-field loss disproportionate to that predicted by age and temporal retinal nerve fiber layer thickness. The primary outcome was the 3-month change in visual-field MD, assessed using multivariable linear regression. Results The mean age was 65.0 ± 12.1 years, and 45 patients (60.0%) were male; 40 (53.3%) had nonfunctioning and 35 (46.7%) had functioning tumors, and 37 (49.3%) underwent TSA. Visual-field MD improved from − 6.02 ± 3.26 dB to -2.98 ± 2.17 dB at 3 months (P < 0.001), with greater improvement in TSA than non-TSA patients (4.41 ± 2.64 vs 1.72 ± 1.34 dB, P < 0.001). TSA (P < 0.001), younger age (P = 0.003), and higher VFODI (P < 0.001) were independent predictors of greater improvement, whereas functional status was not. Conclusions Visual function improved substantially within 3 months after pituitary tumor management. TSA was independently associated with greater early visual-field recovery, whereas functional status was not. Higher VFODI, reflecting a functional deficit disproportionate to structural damage, was strongly associated with recovery and may represent a novel biomarker of reversible chiasmal dysfunction.