Prognostic factors for visual recovery after transsphenoidal pituitary adenectomy

Pituitary adenomas often cause deficits in visual acuity (VA) and visual field (VF) due to compression of the optic chiasm. This study is to identify factors most likely to predict the prognosis of VA and VF after transsphenoidal pituitary adenectomy.

Clinical records of patients who underwent transsphenoidal pituitary adenectomy were retrospectively reviewed. Data analysed included systemic and visual symptom duration, tumour size, presence of suprasellar tumour extension, histological classification of tumour, VA, and VF. VFs were determined using the Goldmann VF test and quantified according to methods outlined by the American Medical Association.

One-hundred and seventy eyes from 85 patients were included. Systemic and visual symptom duration, pre- and postoperative tumour size, and age did not correlate with postoperative VA or VF score. Patients with normal preoperative VA had a better postoperative VA than that of patients with preoperative VA of 20/30 or worse. Patients with normal preoperative VA had better postoperative VF score than that of patients with preoperative VA of 20/70 or worse. Postoperative VF score was lower in the preoperative ≥ 2 quadrant field loss group than in the ≤ 1 quadrant field loss group. Postoperative VA was worse in the ≥ 2 quadrant loss group than in the normal field group. Preoperative VA correlated with postoperative VA and VF score, and preoperative VF score correlated with postoperative VF score but not with VA.

Preoperative VA is a prognostic factor for postoperative VA and VF. Preoperative VF is predictive of postoperative VF and postoperative VA in cases with severe VF loss.