Prognostic Utility of Optical Coherence Tomography for Long-Term Visual Recovery Following Pituitary Tumor Surgery

Area of Science:

• Ophthalmology
• Neurosurgery
• Medical Imaging

Background:

• Optic chiasm decompression surgery is performed for pituitary and parasellar tumors.
• Predicting long-term visual recovery after surgery is crucial for patient management.
• Optical coherence tomography (OCT) provides detailed imaging of the optic nerve.

Purpose of the Study:

• To investigate the association between OCT parameters and long-term visual recovery after optic chiasm decompression.
• To identify predictors of sustained visual function post-surgery.

Main Methods:

• A prospective, longitudinal cohort study included 239 patients undergoing tumor resection.
• Best-corrected visual acuity, visual fields, and OCT measurements (RNFL thickness, macular parameters) were assessed preoperatively and at 6 weeks, 6 months, and 2 years postoperatively.
• Long-term recovery was defined by visual acuity (logMAR ≤ 0) and visual field (mean deviation > -3) at 24 months.

Main Results:

• Increased inferior RNFL thickness was associated with better long-term visual field recovery (OR: 1.26).
• Greater superior RNFL thickness correlated with improved visual acuity recovery (OR: 1.13).
• A multivariable risk prediction model incorporating age, preoperative vision, and RNFL thickness achieved a C-statistic of 0.83 for predicting visual field recovery.

Conclusions:

• Preoperative RNFL thickness is a significant predictor of long-term visual recovery and maintenance after optic chiasm decompression.
• The developed risk prediction model can aid in preoperative patient counseling and prognosis.
• OCT parameters offer valuable insights into visual outcomes following chiasmal decompression surgery.