Factors Influencing Visual Field Recovery after Transsphenoidal Resection of a Pituitary Adenoma

This study aimed to analyze the factors influencing visual field recovery after transsphenoidal approach-tumor resection (TSA-TR) in pituitary adenoma patients with visual field defects (VFDs).

We retrospectively evaluated 102 eyes of 102 patients with VFDs induced by pituitary adenomas who underwent TSA-TR between January 2010 and December 2015. All patients had been observed for more than one year. The severity of the VFD in each patient was evaluated using the mean deviation (MD) and pattern standard deviation in the most-affected eye. Clinical and demographic data such as preoperative visual acuity and visual field, age, sex, tumor volume, neurological symptoms at diagnosis, duration of symptoms, patterns of the preoperative VFD, and preoperative central VFD were investigated and analyzed for association with recovery of the visual field.

Recovery from VFDs occurred in 71 (69.6%) eyes after a mean period of 18.36 ± 5.21 months. The recovery group was younger (p = 0.003), had higher preoperative MD values (p = 0.016), and had better preoperative visual acuity (p = 0.03), compared with the non-recovery group. Preoperative central VFD (p = 0.006) and preoperative bilateral VFD (p = 0.016) were significantly less frequent in the recovery group. Multivariate logistic regression revealed that age at diagnosis (odds ratio [OR], 0.962; p = 0.022), preoperative MD (OR, 1.069; p = 0.046), preoperative central VFD (OR, 0.212; p = 0.039), and preoperative bilateral VFD (OR, 0.212; p = 0.035) were associated with visual field recovery after TSA-TR.

Younger age, higher preoperative MD, and the preoperative abscence of central VFD or bilateral VFD were favorable factors influencing visual field recovery after TSA-TR in patients with pituitary adenomas. An understanding of the associated clinical factors may help predict visual outcomes after TSA-TR in pituitary adenoma patients with VFDs.