Visual Fields at Presentation and after Trans-sphenoidal Resection of Pituitary Adenomas

Abstract

Purpose: To evaluate visual field changes in patients with pituitary adenomas following trans-sphenoidal surgery.

Methods: Eighteen patients with pituitary adenomas underwent a complete ophthalmic assessment and visual field analysis using the Humphrey Field Analyzer 30-2 program before and after trans-sphenoidal surgical resection at the Himalayan Institute of Medical Sciences over a one year period. Visual acuity, duration of symptoms, optic nerve head changes, pattern of visual field defects, and variables such as mean deviation and visual field index were compared.

Results: Thirty-six eyes of 18 patients including 10 male and 8 female subjects with mean age of 35.1±9.9 years and histologically proven pituitary adenoma were included. Mean visual acuity at presentation was 0.29 logMAR which improved to 0.21 logMAR postoperatively (P = 0.305). Of 36 eyes, 24 (66.7%) had visual field defects including temporal defects in 12 eyes (33.3%), non-specific defects in 10 eyes (27.8%), and peripheral field constriction in 2 eyes (5.6%). Mean deviation of visual fields at presentation was -14.28 dB which improved to -11.32 dB postoperatively. The visual field index improved from 63.5% to 75% postoperatively. Favorable visual field outcomes were correlated with shorter duration of symptoms and absence of optic nerve head changes at presentation.

Conclusion: Visual field defects were present in two thirds of patients at presentation. An overall improvement in vision and visual fields was noted after surgical resection. An inverse correlation was found between the duration of symptoms and postoperative visual field recovery, signifying the importance of early surgical intervention.

Keywords: Mean Deviation; Pituitary Adenoma; Trans-sphenoidal Resection; Visual Field; Visual Field Index.

Figure 1

Age and sex distribution of the study population.

Figure 2

Pre- and postoperative patterns of visual field defects.