Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Republic of Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
J Neurol Sci. 2020 Jul 15;414:116823. doi: 10.1016/j.jns.2020.116823. Epub 2020 Apr 6.
Optic nerve compression by mass lesions at the optic chiasm leads to loss of visual function which can be recovered after decompression surgery. In this study, we evaluated the prognostic ability of macular ganglion cell layer (mGCL) thickness measured with spectral-domain optical coherence tomography (SD-OCT) for predicting postoperative visual outcome of compressive optic neuropathy (CON) related to parasellar tumors.
This observational cohort study used data from the Department of Neurosurgery and Ophthalmology, Seoul National University Bundang Hospital between 2013 and 2018. Seventy-nine eyes from 79 patients with CON due to parasellar tumors who underwent surgery were included. Patients were divided into either a visual recovery group or a non-recovery group according to the degree of postoperative visual field (VF) impairment. SD-OCT scanning with automated segmentation was performed to measure the circumpapillary retinal nerve fiber layer (cpRNFL) and the mGCL thickness in the nine macular subfields as defined by the ETDRS and 8 × 8 posterior pole grid. Correlations between preoperative cpRNFL thickness, mGCL thickness and postoperative VF sensitivity were assessed. The prognostic ability of mGCL thickness for predicting visual recovery after surgical decompression in each ETDRS subfield and posterior pole grid quadrant was evaluated.
The central inferonasal and superonasal quadrant mGCL thicknesses measured by the 8 × 8 posterior pole grid showed the best predictability of postoperative visual outcome (AUROC = 0.963 and 0.953, respectively), which was superior to the prognostic power of the average cpRNFL. The central inferonasal quadrant mGCL thickness significantly correlated with the superotemporal quadrant VF sensitivity (R = 0.589).
The mGCL thickness in the central nasal quadrants measured by SD-OCT is an excellent predictor of visual recovery after chiasmal decompression.
视交叉处的肿块压迫视神经会导致视觉功能丧失，减压手术后可恢复。本研究旨在评估应用频域光学相干断层扫描（SD-OCT）测量的黄斑神经节细胞层（mGCL）厚度对视神经压迫病变（CON）术后视觉预后的预测能力，CON 与鞍旁肿瘤有关。
本观察性队列研究的数据来自于 2013 年至 2018 年期间首尔国立大学盆唐医院神经外科和眼科。共纳入 79 例因鞍旁肿瘤导致 CON 而行手术的患者的 79 只眼。根据术后视野（VF）损害程度，将患者分为视觉恢复组和非恢复组。采用自动分割 SD-OCT 扫描，测量 9 个黄斑区的节细胞层（mGCL）厚度和 8x8 后极网格的环周视网膜神经纤维层（cpRNFL）厚度。评估术前 cpRNFL 厚度、mGCL 厚度与术后 VF 敏感性之间的相关性。评估每个 ETDRS 亚区和后极网格象限的 mGCL 厚度对手术减压后视力恢复的预测能力。
8x8 后极网格测量的中央鼻下象限和鼻上象限 mGCL 厚度对术后视觉结局的预测能力最佳（AUROC 分别为 0.963 和 0.953），优于平均 cpRNFL 的预测能力。中央鼻下象限 mGCL 厚度与上颞象限 VF 敏感性显著相关（R=0.589）。
SD-OCT 测量的中央鼻区 mGCL 厚度是视交叉减压后视力恢复的良好预测指标。
