Ogra Siddharth, Nichols Andrew D, Stylli Stanley, Kaye Andrew H, Savino Peter J, Danesh-Meyer Helen V
Department of Ophthalmology, Faculty of Medical & Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, Australia.
J Clin Neurosci. 2014 May;21(5):735-40. doi: 10.1016/j.jocn.2014.01.005. Epub 2014 Mar 18.
Our purpose was to analyse the demographics, prevalence and pattern of visual field defects in patients with pituitary adenoma. We prospectively recruited 103 consecutive patients (206 eyes) presenting to a neurosurgical unit with pituitary adenoma. Ophthalmological examination and standard automated perimetry (Humphrey, 24-2 threshold) was performed. Severity of visual field defects was also assessed. The mean population age was 53.9 years (standard deviation=15). Visual loss was the most common reason for presentation (39%) followed by endocrine abnormality (21%) and headache (15%). Patients with endocrine abnormality on presentation were 10.9 years younger than those presenting with visual loss (p=0.001). Bitemporal defects were the most prevalent pattern (n=22, 41%) followed by homonymous defects (n=7, 13%). Of the patients with visual field loss, 33% had unilateral visual field defects. The mean visual acuity in those with bitemporal defects was 6/7.5 with half of these patients having 6/6 vision in both eyes. In conclusion, the majority of patients with pituitary adenoma have visual acuity better than 6/7.5 despite having visual field defects. While a bitemporal pattern of visual field loss is the most common, a significant proportion of patients had unilateral and altitudinal defects. Assessment of the visual field is essential to rule out chiasmal compression.
我们的目的是分析垂体腺瘤患者的人口统计学特征、视野缺损的患病率及模式。我们前瞻性地招募了103例连续就诊于神经外科的垂体腺瘤患者（206只眼）。进行了眼科检查及标准自动视野计检查（Humphrey，24-2阈值）。还评估了视野缺损的严重程度。患者的平均年龄为53.9岁（标准差=15）。视力丧失是最常见的就诊原因（39%），其次是内分泌异常（21%）和头痛（15%）。就诊时存在内分泌异常的患者比存在视力丧失的患者年轻10.9岁（p=0.001）。双颞侧缺损是最常见的模式（n=22，41%），其次是同侧偏盲缺损（n=7，13%）。在有视野缺损的患者中，33%有单侧视野缺损。双颞侧缺损患者的平均视力为6/7.5，其中一半患者双眼视力为6/6。总之，大多数垂体腺瘤患者尽管有视野缺损，但视力优于6/7.5。虽然双颞侧视野缺损模式最为常见，但仍有相当比例的患者存在单侧及象限性缺损。视野评估对于排除视交叉受压至关重要。
