Toumi Elsa, Almairac Fabien, Mondot Lydiane, Themelin Albert, Decoux-Poullot Anne-Gaëlle, Paquis Philippe, Chevalier Nicolas, Baillif Stéphanie, Nahon-Esteve Sacha, Martel Arnaud
Ophthalmology Department, University Hospital of Nice, Université Côte d'Azur, 06000 Nice, France.
Neurosurgery Department, University Hospital of Nice, Université Côte d'Azur, 06000 Nice, France.
Diagnostics (Basel). 2024 Aug 12;14(16):1747. doi: 10.3390/diagnostics14161747.
Although visual field (VF) defects are common in compressive pituitary adenoma (CPA), their pathophysiology has not been fully elucidated. The mechanical theory (i.e., direct compression of the optic chiasm by the CPA) and the vascular theory (i.e., compression of the vessels supplying the visual path by the CPA) or their association could explain the visual impairment. The aim of this study was to determine whether the vascular density (VD) improved after surgical decompression of the optic chiasm in CPA patients and whether OCT-A could help to identify predictive factors for postoperative visual recovery.
A prospective controlled study was conducted in patients who underwent transsphenoidal pituitary adenoma surgery. Patients were divided into two groups: with CPA and without CPA (NCPA). All patients underwent a neuro-ophthalmological examination, VF testing, macular and optic disc structural OCT [retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses] and OCT-A before and then 1 and 6 months after surgery.
Twenty-four eyes and fourteen eyes were included, respectively, in the CPA and NCPA groups. None of the VD parameters assessed by OCT-A were significantly improved after surgery in the CPA group. In the CPA group, the mean macular superficial VD was significantly decreased at 6 months. The multivariate analysis failed to identify any preoperative parameters predictive of postoperative VF improvement.
Our preliminary findings suggest that the visual impairment observed in CPA patients could not be explained by the vascular theory. None of the preoperative OCT-A parameters allowed a postoperative VF recovery assessment. Trial registration number NCT04074642, ID-RCB 2019-A01186-51 date of registration 30 July 2019.
尽管视野（VF）缺损在垂体腺瘤（CPA）中很常见，但其病理生理学尚未完全阐明。机械理论（即CPA对视交叉的直接压迫）和血管理论（即CPA对供应视觉通路的血管的压迫）或它们之间的关联可以解释视力损害。本研究的目的是确定CPA患者视交叉手术减压后血管密度（VD）是否改善，以及光学相干断层扫描血管造影（OCT-A）是否有助于识别术后视力恢复的预测因素。
对接受经蝶窦垂体腺瘤手术的患者进行前瞻性对照研究。患者分为两组：患有CPA和未患有CPA（NCPA）。所有患者在手术前、术后1个月和6个月均接受了神经眼科检查、VF测试、黄斑和视盘结构光学相干断层扫描[视网膜神经纤维层（RNFL）和神经节细胞复合体（GCC）厚度]以及OCT-A检查。
CPA组和NCPA组分别纳入了24只眼和14只眼。CPA组术后通过OCT-A评估的VD参数均无显著改善。在CPA组中，黄斑浅表VD平均值在6个月时显著降低。多因素分析未能识别出任何预测术后VF改善的术前参数。
我们的初步研究结果表明，CPA患者中观察到的视力损害无法用血管理论来解释。术前OCT-A参数均无法进行术后VF恢复评估。试验注册号NCT04074642，ID-RCB 2019-A01186-51，注册日期2019年7月30日。
