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.
J Clin Neurosci. 2021 Apr;86:252-259. doi: 10.1016/j.jocn.2021.01.007. Epub 2021 Feb 16.
Significant restoration of visual function can occur following pituitary tumor resection, although the time course of visual recovery remains poorly understood. This single-centre, two-year, prospective cohort study investigated the temporal patterns of visual recovery in consecutive patients undergoing pituitary tumor resection, between 2009 and 2018. Eyes were stratified based on pre-operative optical coherence tomography (OCT) retinal nerve fibre layer (RNFL) thickness measurements, with thin RNFL being defined as those within the fifth-percentile of age-matched normative values, and normal RNFL as those above the fifth-percentile. Visual function and OCT parameters were assessed pre-operatively, and at 6 weeks, 6 months, and 2 years post-operatively. 456 eyes of 228 patients (mean ± SD age, 53 ± 15 years) were included, of which 114 (25%) eyes had thin RNFL pre-operatively. Visual field recovery was observed in both groups during the first 6 weeks post-operatively (all Q ≤ 0.02), although improvements in visual field parameters between 6 weeks to 6 months were limited to eyes with thin RNFL (both Q < 0.05). No further improvements in visual function were detected beyond 6 months in both groups (both Q > 0.50). Similar trends were observed in linear regression analysis according to baseline visual function in both groups. In summary, eyes with normal RNFL thickness at baseline experienced most of their recovery within the first six weeks following surgery, while eyes with thin RNFL exhibited gradual improvements during the first six months. These findings have important implications when providing patient counselling and prognostication in the pre-operative setting.
术后视力可能会得到显著恢复，尽管视觉恢复的时间进程仍知之甚少。本单中心、为期两年的前瞻性队列研究，调查了 2009 年至 2018 年间连续接受垂体瘤切除术的患者视觉恢复的时间模式。根据术前光学相干断层扫描（OCT）视网膜神经纤维层（RNFL）厚度测量，将眼睛分为薄 RNFL 和正常 RNFL 两组，其中薄 RNFL 定义为处于与年龄匹配的正常参考值第五百分位以下的 RNFL，正常 RNFL 定义为高于第五百分位的 RNFL。在术前以及术后 6 周、6 个月和 2 年时评估视力和 OCT 参数。共纳入 228 例患者的 456 只眼（平均年龄±标准差，53±15 岁），其中术前 114 只眼（25%）为薄 RNFL。两组患者在术后前 6 周均观察到视野恢复（所有 Q 值均≤0.02），但在 6 周至 6 个月期间，视野参数的改善仅限于薄 RNFL 眼（均 Q 值<0.05）。两组患者在 6 个月后均未发现视力进一步改善（均 Q 值>0.50）。根据两组患者基线视力的线性回归分析也观察到了类似的趋势。综上所述，基线时 RNFL 厚度正常的眼睛在术后前 6 周内恢复最多，而 RNFL 厚度较薄的眼睛在最初 6 个月内逐渐恢复。这些发现对术前为患者提供咨询和预后具有重要意义。
