Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand.
Department of Surgery, University of Melbourne, Parkville, Victoria, Australia; Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Am J Ophthalmol. 2020 Oct;218:247-254. doi: 10.1016/j.ajo.2020.06.004. Epub 2020 Jun 10.
To investigate the association between optical coherence tomography (OCT) parameters and long-term visual recovery following optic chiasm decompression surgery.
Prospective cohort study.
Consecutive patients who underwent pituitary or parasellar tumor resection between January 2009 to December 2018 were recruited in a single-center, 2-year prospective, longitudinal cohort study. Best-corrected visual acuity, visual fields, and OCT retinal nerve fiber layer (RNFL) thickness, macular thickness and volume were assessed preoperatively, and at 6 weeks, 6 months, and 2 years postoperatively. Long-term visual field recovery and maintenance were defined as a mean deviation of >-3 at 24 months, and visual acuity recovery and maintenance were defined as a logarithm of minimal angle of resolution (logMAR) of 0 (Snellen 20/20) or better at 24 months.
A total of 239 patients (129 men, 110 women; mean ± SD age: 52 ± 16 years) were included. Multiple logistic regression analysis demonstrated that increased inferior RNFL thickness (per 10 μm) was associated with higher odds of long-term visual field recovery and maintenance (odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.12-1.41; Q < 0.001), and greater superior RNFL thickness (per 10 μm) was associated with higher odds of visual acuity recovery and maintenance (OR: 1.13; 95% CI: 1.03-1.27; Q = 0.031). A multivariable risk prediction model developed for long-term visual field recovery and maintenance that incorporated age, preoperative visual function, and RNFL thickness demonstrated C-statistics of 0.83 (95% CI: 0.72-0.94).
Preoperative RNFL thickness was associated with long-term visual recovery and maintenance following chiasmal decompression. The multivariable risk prediction model developed in the present study may assist with preoperative patient counseling and prognosis.
研究光学相干断层扫描（OCT）参数与视交叉减压术后长期视力恢复的关系。
前瞻性队列研究。
连续招募 2009 年 1 月至 2018 年 12 月在单中心接受垂体或鞍旁肿瘤切除术的患者，进行为期 2 年的前瞻性纵向队列研究。在术前、术后 6 周、6 个月和 2 年评估最佳矫正视力、视野和 OCT 视网膜神经纤维层（RNFL）厚度、黄斑厚度和体积。长期视野恢复和维持定义为 24 个月时平均偏差> -3，视力恢复和维持定义为 24 个月时对数最小分辨角（logMAR）为 0（Snellen 20/20）或更好。
共纳入 239 例患者（129 例男性，110 例女性；平均年龄±标准差：52 ± 16 岁）。多变量逻辑回归分析表明，下 RNFL 厚度每增加 10 μm（per 10 μm），长期视野恢复和维持的几率更高（比值比[OR]：1.26；95%置信区间[CI]：1.12-1.41；Q < 0.001），上 RNFL 厚度每增加 10 μm（per 10 μm），视力恢复和维持的几率更高（OR：1.13；95% CI：1.03-1.27；Q = 0.031）。为长期视野恢复和维持制定的包含年龄、术前视力和 RNFL 厚度的多变量风险预测模型显示 C 统计量为 0.83（95% CI：0.72-0.94）。
术前 RNFL 厚度与视交叉减压术后长期视力恢复和维持有关。本研究中建立的多变量风险预测模型可用于术前患者咨询和预后。
