Clinical Efficacy of Optical Coherence Tomography to Predict the Visual Outcome After Endoscopic Endonasal Surgery for Suprasellar Tumors

BACKGROUND: Prediction of visual outcome after endoscopic endonasal tumor resection still remains a challenge. We investigated the prognostic value of the preoperative peripapillary retinal nerve fiber layer (pRNFL) using optical coherence tomography for visual outcome after endoscopic endonasal surgery (EES) for suprasellar tumors. METHODS: We retrospectively analyzed 122 patients who underwent EES for sellar and suprasellar tumors between January 2016 and January 2018. We retrospectively analyzed the pre- and postoperative relationship between pRNFL thickness and visual outcome based on visual acuity (visual acuity score) and visual field (mean deviation [MD]). RESULTS: Preoperatively, 216 eyes (mean global pRNFL thickness, 94.3 +/- 12.4 mu m; 88.5%) were included in the normal pRNFL group (>= 70 mu m) and 28 eyes (mean global pRNFL thickness, 54.3 +/- 11.0 mu m; 11.5%) were included in the thin pRNFL group (<70 mu m). There was a very strong correlation between pre- and postoperative pRNFL thickness (r = 0.930). The thin pRNFL group showed a stronger correlation between pre- and postoperative MDs than the normal pRNFL group (r = 0.619 and r = 0.420, respectively; P < 0.01). Multivariate analyses identified pRNFL thickness as the only significant predictor of postoperative visual acuity (odds ratio [OR], 25.02; 95% confidence interval [CI], 7.68-81.50; P < 0.01) and visual field (OR, 39.46; 95% CI, 10.39-149.83; P < 0.01). CONCLUSIONS: Preoperative pRNFL thickness plays a prognostic value in postoperative visual outcome after EES for sellar and suprasellar tumors. Patients with pRNFL thickness >= 70 mu m before surgery are more likely to improve visual outcome than those with thickness <70 mu m.