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Prognostic Value of Optical Coherence Tomography Characteristics in Anterior Visual Pathway Meningiomas
Noa Kapelushnik1, Shai Dror, Ruth Huna-Baron
1The Goldschleger Eye Institute and the Arrow Project (NK, SD, RH-B), Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Background:
Anterior visual pathway meningiomas (AVPM) represent 2.5%-18% of all meningiomas. They may affect visual function, including visual acuity (VA) and visual field (VF). The principal modes of treatment are surgery and radiotherapy. The prognostic value of macular ganglion cell complex count (GCC) thickness has not been assessed in the literature thus far. The purpose of this study was to evaluate the prognostic value of pre-treatment optical coherence tomography (OCT) parameters (retinal nerve fiber layer and GCC) for visual outcomes in patients with AVPM.
Methods:
We retrospectively reviewed the medical records of all patients with AVPM who were treated in the Sheba Medical Center between 2011 and 2020. Included were patients with valid data containing preintervention OCT findings on the CIRRUS device and a minimum follow-up of 6 months. Preintervention and postintervention data on comprehensive ophthalmic examinations and OCT parameters of the affected eyes were retrieved. The correlation between preintervention OCT parameters and the visual outcome was assessed. The patients were also divided into 2 groups according to preintervention GCC (thin vs normal), and the visual outcome was compared between groups.
Results:
In total, 186 patients' medical records were analyzed, and 38 patients who met the inclusion criteria were included in the study (mean age at diagnosis 52.8 ± 12.2 years, 28 women). Twenty-nine patients had 1 affected eye, and 9 had bilateral insult. A higher preinterventional average GCC was associated with better VA at 6 months, 1 year, and 2 years after intervention (r = -0.5, P ≤ 0.004, 0.005, and 0.03, respectively). There was a significant correlation between preinterventional GCC and VF mean deviation 2 years after intervention (r = 0.7, P ≤ 0.001). The thinner the GCC, the more prominent was the change in VA from before intervention to 2 years after intervention ( P ≤ 0.008). Correction for multiple comparisons with the Benjamini-Hochberg procedure did not change the significance of our findings.
Conclusions:
OCT parameters (GCC) have a predictive value in AVPM. There is strong correlation between preinterventional GCC and VA shortly after the intervention. Although a thin GCC is generally considered a negative prognostic factor, improvement in clinical parameters was also evident in patients with thin GCC. The potential of improvement despite preinterventional GCC thinning can add to the clinical discussion of the prognosis, and therefore, we recommend the patients with AVPM to undergo OCT and to be advised that GCC thinning alone should not be used as a major criterion in deciding whether treatment should be pursued.
Insights
Optical coherence tomography (OCT) ganglion cell complex (GCC) thickness predicts visual outcomes in anterior visual pathway meningiomas (AVPM). Thinner GCC correlates with worse visual acuity and visual field, but some improvement is possible even with reduced GCC.
Area of Science:
- Ophthalmology
- Neuro-oncology
- Medical Imaging
Background:
- Anterior visual pathway meningiomas (AVPM) are tumors affecting vision, with treatments including surgery and radiotherapy.
- The prognostic significance of macular ganglion cell complex (GCC) thickness in AVPM has not been previously established.
- Assessing pre-treatment optical coherence tomography (OCT) parameters is crucial for predicting visual recovery.
Purpose of the Study:
- To evaluate the prognostic value of pre-treatment OCT parameters, specifically retinal nerve fiber layer and GCC thickness, for visual outcomes in AVPM patients.
- To determine the correlation between pre-intervention GCC thickness and subsequent visual acuity (VA) and visual field (VF) in AVPM patients.
Main Methods:
- Retrospective review of 38 AVPM patients treated between 2011-2020 with pre-intervention OCT (CIRRUS device) and at least 6 months follow-up.
- Analysis of pre- and post-intervention ophthalmic examinations and OCT parameters.
- Correlation assessment between pre-intervention OCT parameters (GCC) and visual outcomes (VA, VF), with comparison between thin vs. normal GCC groups.
Main Results:
- Higher pre-intervention average GCC thickness was significantly associated with better VA at 6 months, 1 year, and 2 years post-intervention.
- A significant correlation was found between pre-intervention GCC and VF mean deviation 2 years after intervention.
- Thinner GCC was linked to more pronounced changes in VA from pre-intervention to 2 years post-intervention, though clinical improvement was observed even in these cases.
Conclusions:
- Pre-treatment OCT-derived GCC thickness is a valuable predictor of visual outcomes in AVPM.
- While thinner GCC generally indicates a poorer prognosis, potential for clinical improvement exists, suggesting GCC thinning alone should not solely guide treatment decisions.
- OCT assessment of GCC is recommended for AVPM patients to aid in prognosis discussions and treatment planning.
