Predicting Visual Outcome After Treatment of Pituitary Adenomas With Optical Coherence Tomography

PURPOSE: To evaluate if optical coherence tomography (OCT), by providing an objective measure of the retinal nerve fiber layer (RNFL) thickness, offers a reliable prediction of visual outcome. DESIGN: Prospective cohort study. METHODS: Thirty-seven eyes of 19 consecutive patients from a single hospital suffering from pituitary adenomas compressing the anterior visual pathways were included, and compared with 46 eyes of 23 controls. Exclusion criteria included any previous treatment of pituitary adenoma and high myopia. Seventeen patients underwent trans-sphenoidal surgery and two patients with macroprolactinomas received dopamine agonists. Automated visual fields (VF) and OCT (fast,RNFL program) were performed before treatment, and two weeks and three months after treatment. RESULTS: Among the eyes with a VF defect before treatment, the odds of complete recovery after three months from the initial VF defect was multiplied by 1.29 for each increase by I micron of mean RNFL (odds ratio [OR], 1.29; P =.037). This was independent from age and duration of symptoms, which carried their own prognostic value. Inferior RNFL was a very strong prognostic factor; OR, 6.31 per micron (P =.0000). CONCLUSION: RNFL thinning measured by OCT puts the patient at decreased chance of recovery of an initial VF defect three months after treatment in pituitary adenomas compressing the anterior visual pathways. Further studies will establish how useful this tool is for long,term visual outcome. (Am J Ophthalmol 2009;147: 64-70. (c) 2009 by Elsevier Inc. All rights reserved.)