Long-term retinal microvascular alterations after endoscopic endonasal surgery in patients with sellar region tumors

To evaluate retinal microcirculation changes at the 3^rd and 12^th months following endoscopic endonasal surgery in patients with sellar region tumors using optical coherence tomography angiography (OCT-A).

This prospective longitudinal observational study included 78 eyes of 39 patients with sellar tumors and 78 eyes of 39 age- and gender-matched healthy controls. Standard automated perimetry and OCT-A were performed preoperatively and at 3- and 12-month follow-ups. Visual field (VF) recovery was assessed using mean deviation (MD) values, and correlations between preoperative structural parameters and postoperative visual outcomes were analyzed.

Baseline OCT-A values revealed significantly reduced papillary and foveal vessel densities in almost all quadrants in sellar tumor patients compared to controls (P<0.05, respectively). While VF MD values improved significantly postoperatively (P<0.001), no significant improvement was observed in microvascular vessel density or retinal nerve fiber layer (RNFL) thickness (P>0.05, respectively); instead, a tendency toward reduction was noted over 12mo. Correlation analysis between postoperative MD values and preoperative parameters showed a strong positive correlation with the superior quadrant of papillary vessel density (r=0.703, P<0.001) and RNFL thickness (r=0.518, P<0.001).

Although decompressive surgery improves visual function, retinal microvascular alterations appear to deteriorate over time. These findings suggest that irreversible neurovascular damage occurs despite surgical intervention, emphasizing the importance of early diagnosis and treatment in patients with chiasmal compression. OCT-A may serve as a valuable prognostic tool for assessing structural and functional recovery in these patients.