Prognostic factors for postoperative visual outcome in surgically treated suprasellar meningiomas

Introduction. The prognosis of postoperative visual acuity in patients with surgically treated suprasellar meningiomas is influenced not only by the size and precise localization of meningiomas in the optochiasmatic region and their compressive effect, but also by certain parameters, such as the age of patient, duration of symptoms, and preoperative visual acuity. The purpose of this study was to analyze the influence of these factors on postoperative visual acuity in the patients with surgically treated optochiasmatic meningioma as well as to determine their prognostic value in the recovery of visual function after surgery. Material and Methods. The study sample consisted of 43 patients operated for suprasellar meningioma. All tumors were diagnosed by computed tomography or nuclear magnetic resonance scans. Visual acuity was analyzed both before surgery and six months after surgery. The effects of age, preoperative visual loss, duration of visual symptoms and tumor size on visual outcome were analyzed. Results. Postoperative improvement of visual acuity was observed in 50% of eyes (68.4% of patients). Visual outcome was better in the younger patients. The patients with better preoperative visual acuity had better postoperative visual acuity outcome. Chances of achieving better postoperative visual function and favorable tumor resection outcome were inversely proportional to the increased length of history of disease and tumor size. Conclusion. Postoperative visual acuity prognosis in suprasellar meningioma surgery was favorably affected by the mean duration of symptoms of less than 24 months, tumor size less than 30 mm, and preoperative visual acuity loss below 0.1.

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Outcome of visual acuity after surgical removal of pituitary adenomas

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1306296g ◽

2013 ◽

Vol 141 (5-6) ◽

pp. 296-303 ◽

Cited By ~ 1

Author(s):

Desanka Grkovic ◽

Tatjana Bedov

Keyword(s):

Visual Acuity ◽

Prognostic Factors ◽

Tumor Size ◽

Pituitary Adenomas ◽

Tumor Resection ◽

Visual Outcome ◽

Surgical Removal ◽

Moderate Degree ◽

Duration Of Symptoms ◽

Chisquare Test

Introduction. Pituitary adenomas with suprasellar extension may produce anterior visual pathway compression, resulting in characteristic visual deficit. Surgical decompression of these structures prevents further visual deterioration and its postop? erative recovery. Objective. The aim of this study was to investigate pre? and postoperative visual acuity (VA) in patients with pituitary ad? enomas, and to detect the influence of prognostic factors, such as symptoms duration, degree of visual acuity reduction and tumor size in the assessment of the prognosis of postoperative visual function. Methods. We analyzed 40 consecutive patients who fulfilled three criteria: evidence of preoperative visual dysfunction, transsphenoidal or transfrontal tumor resection and hystologically verified pituitary adenoma. A visual examination was performed under standard conditions, pre and postoperatively (10 days, one month and six months after surgery). A paired t?test was used to assess the differences of pre? and postoperative characteristics values, and the Chisquare test of independence in the assessment of the influence of prognostic factors. Results. Postoperative improvement of VA was seen in 84.61% patients (68% eyes). Eyes with preoperative mild and moderate degree of VA reduction showed improvement in 89.65% eyes in contrast to 22.60% eyes with preoperative severe reduction of VA, which was all statistically significant. Eyes in patients with tumor smaller than 20 mm had improvement of VA in 91.66% eyes, while eyes with tumor larger than 40 mm had improvement of VA in 61.11% eyes, which was statistically significant. When symptoms duration was below two years the improvement of VA was detected in 65.38% eyes as related to 50% eyes with symptoms duration exceeding two years, which was not statistically significant. Conclusion. Pituitary adenomas commonly cause visual impairment. Postoperatively the majority of patients show a distinct improvement of visual acuity. The degree of preoperative visual loss and tumor size influence the final visual outcome, and not the duration of symptoms.

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Factors Influencing Visual Outcome after Penetrating Keratoplasty Combined with Intraocular Lens Implantation

European Journal of Ophthalmology ◽

10.1177/112067210301300203 ◽

2003 ◽

Vol 13 (2) ◽

pp. 134-138 ◽

Cited By ~ 3

Author(s):

J.B. Jonas ◽

R.M. Rank ◽

W.M. Budde ◽

G. Sauder

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Penetrating Keratoplasty ◽

Visual Outcome ◽

Intraocular Lens Implantation ◽

Postoperative Visual Acuity ◽

Factors Influencing ◽

Lens Implantation ◽

Preoperative Visual Acuity

Purpose To establish which factors influence visual outcome after penetrating keratoplasty combined with intraocular lens implantation. Methods This retrospective noncomparative clinical interventional case series study included 135 consecutive patients (mean age 70.2 ± 13.6 years) who underwent central penetrating allogenic keratoplasty combined with intraocular lens (IOL) implantation, all operated by the same surgeon. There were 79 triple procedures, 33 keratoplasties combined with an exchange of IOL, and 23 penetrating keratoplasties combined with a secondary implantation of a posterior chamber lens. Mean follow-up was 28.3 ± 18.7 months (range 3.3–112 months). Reasons for keratoplasty were herpetic or traumatic corneal scars or defects (46), Fuchs corneal endothelial dystrophy (22), pseudophakic or aphakic bullous keratopathy (49), corneal endothelial decompensation due to other reasons (15), and keratoconus (3). Main outcome measures were postoperative visual acuity and gain in visual acuity. Results Mean postoperative visual acuity and mean gain in visual acuity were 0.33 ± 0.21 (median 0.30) and 0.25 ± 0.20 (median 0.20), respectively. Compared with the preoperative measurements, mean visual acuity increased in 129 patients (129/135, 95.6%). Factors influencing postoperative visual outcome and gain in visual acuity were preoperative visual acuity (p<0.005), reason for keratoplasty (p<0.005), and diameter of the graft (p = 0.046). Postoperative visual outcome was independent of age, sex, right or left eye, presence of diabetes mellitus, preoperative refractive error, length of follow-up, duration of surgery, and preoperative intraocular pressure. Conclusions The most important factors influencing visual outcome after central penetrating allogenic keratoplasty combined with IOL surgery are preoperative visual acuity, graft size, and reason for keratoplasty. Other factors such as age, sex, diabetes mellitus, and preoperative refractive error do not substantially influence postoperative visual outcome.

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Early Post-operative Visual Outcome in Patient with Pituitary Adenoma

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v28i2.17182 ◽

2013 ◽

Vol 28 (2) ◽

pp. 108-115

Author(s):

Md Rezaul Amin ◽

Haradhon Deb Nath ◽

M Afzal Hossain ◽

Kanak Kanti Barua

Keyword(s):

Pituitary Adenoma ◽

Visual Field ◽

Visual Function ◽

Tumor Resection ◽

Visual Outcome ◽

Visual Field Defects ◽

Bivariate Analysis ◽

P Value ◽

Duration Of Symptoms ◽

Visual Status

Background: Pituitary adenoma, which accounts for 17.4% of all brain tumors, is the third most frequently diagnosed brain tumor, following intracranial glioma and meningioma. The visual disturbance in pituitary adenoma ranged from blurring of vision with or without headache to total loss of vision. In patients with visual field defects, bitemporal hemianopia was the commonest visual field defect. Early improvement of visual function is one of the major indication surgery. Objective: The purpose of this study was to comparison between the pre and post-operative visual parameters and to find out the value in assessment of the prognosis of early postoperative visual function and also to find out the factor which influence the early post-operative visual outcome. Methods: A prospective study was done from September 2010 to April 2012 in the department of neurosurgery, Bangabandhu Sheikh Mujib Medical University, 30 cases of pituitary adenoma had been included in this study of those who were presented with visual symptoms. Visual assessment was done before the operation and outcome was analyzed at discharged from hospital. Results: Within 60 eyes, 13 (43.3%) patients presented with blindness of one or both eyes. 10 (33.3%) presented with uniocular and 3 (10.0%) presented with binocular blindness. Duration of the symptoms ranged from 2 months to 48 months. Patients underwent either transcranial or transsphenoidal tumor decompression. At discharge out of 30 patients, 23 (76.7%) showed improvement, 2 (6.6%) patients were deteriorated post-operatively. P value was <0.001, in z test, Z=91.5, which was highly significant. Post-operative visual status was analyzed with age, sex, duration of symptoms, suprasellar extension, and methods of surgery and extent of tumor resection to find out that any other factor influenced the visual outcome. In bivariate analysis it was shown that only duration of the symptoms only other factor that influenced the visual outcome (statistically significant, p value 0.017). Conclusion: With this study it was statistically proved that pre-operative visual status is the main factor for improvement of early post-operative visual outcome in pituitary adenoma and duration of symptoms had also influence the early post-operative visual outcome. Duration less than 12 months had a favorable outcome. DOI: http://dx.doi.org/10.3329/bjn.v28i2.17182 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 108-115

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Natural History of Idiopathic Epiretinal Membrane in Eyes with Good Vision Assessed by Spectral-Domain Optical Coherence Tomography

Ophthalmologica ◽

10.1159/000437058 ◽

2015 ◽

Vol 234 (2) ◽

pp. 91-100 ◽

Cited By ~ 12

Author(s):

Ik Soo Byon ◽

Gang Yun Pak ◽

Han Jo Kwon ◽

Kyong Ho Kim ◽

Sung Who Park ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Natural History ◽

Visual Function ◽

Epiretinal Membrane ◽

Membrane Separation ◽

Early Stage ◽

Optical Coherence ◽

Idiopathic Epiretinal Membrane ◽

History Of

Purpose: To investigate the natural history of idiopathic epiretinal membrane (ERM) in eyes with good visual function using optical coherence tomography (OCT). Methods: Sixty-two eyes of 58 patients with idiopathic ERM, visual acuity of 20/40 or better, and no significant metamorphopsia were included. The best corrected visual acuity (BCVA), central macular thickness (CMT), membrane configuration, and ellipsoid zone signal data over 24 months were retrospectively analyzed. Based on OCT findings, ERM configurations were categorized as global attachment (GA), partial attachment (PA), pseudohole, and vitreomacular traction (VMT). Results: The mean BCVA and CMT did not change significantly between baseline and 24 months. GA, PA, pseudohole, and VMT types were observed in 33, 19, 9, and 1 eye at baseline, and in 20, 22, 10, and 1 eye at 24 months, respectively. A membrane configuration change was noted in 24 eyes (38.7%) during follow-up, and the distribution shifted from GA to the other types (p < 0.001). Six eyes had visual loss due to membrane progression, and 4 eyes had spontaneous membrane separation. Of the 10 eyes with progression or separation, 6 were of the PA type. Conclusions: Although the BCVA remains stable over 2 years in most idiopathic ERM eyes with good visual function at baseline, the membrane configuration may change, affecting visual acuity. The GA type would be an early stage, and the PA type is prone to changes in visual acuity.

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Demographic pattern, clinical profile and visual outcome of patients with optic neuritis in a tertiary level eye care center of eastern Nepal

Health Renaissance ◽

10.3126/hren.v11i3.9641 ◽

2014 ◽

Vol 11 (3) ◽

pp. 250-253

Author(s):

BG Shrestha ◽

M Sharma ◽

P Lavaju ◽

SM Pokharel ◽

N Agrawal ◽

...

Keyword(s):

Visual Acuity ◽

Optic Neuritis ◽

Care Center ◽

Visual Outcome ◽

Clinical Profile ◽

Response To Treatment ◽

Female Ratio ◽

History Of ◽

Intravenous Steroids ◽

Time Of Presentation

Introduction: Optic neuritis is one of the common causes of sudden visual impairment. Early diagnosis and treatment with intravenous steroids can hasten visual recovery. Objective: To analyze the demographic pattern, clinical profile, and response to treatment with pulse methylprednisolone in patients presenting with optic neuritis. Methods: A hospital based retrospective analysis of records of patients with optic neuritis presenting at BPKIHS between April 2010 to February 2012 was carried out. Demographic pattern, clinical profile and visual outcome at the time of presentation and discharge were recorded. Results: Thirty-five patients (44 eyes) presented with optic neuritis. A total of 33 eyes (75%) had papillitis and 11 eyes (25%) had retrobulbar optic neuritis. Male to female ratio was 2.18:1. The mean age at presentation was 31.20 ± 17.07 years. Diminution of vision was the commonest mode of presentation. Bilateral involvement was seen in 9 patients (25.71%). The 38 eyes (86.36%) had abnormal pupillary reaction. Eight patients (22.85%) had preceeding history of trauma, 1 (2.85%) had ethmoidal sinusitis and 1 (2.85%) otitis media. At the time of discharge 32 eyes (72.7%) showed recovery in visual acuity after pulse I.V. methylprednisolone therapy. Duration at presentation, visual acuity at presentation and diagnosis did not affect the final visual outcome (p=0.486, p=0.162 and p=0.122 respectively). Conclusion: Majority of patients presented with papillitis of idiopathic origin. Most of the cases were unilateral. Most patients with visual acuity of at least perception of light or better at the time of presentation improved after pulse I.V. methylprednisolone therapy. DOI: http://dx.doi.org/10.3126/hren.v11i3.9641 Health Renaissance 2013;11(3):250-253

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Visual Outcome of Combined Descemet Stripping Endothelial Keratoplasty and Sutured Scleral Fixated Intraocular Lens in Endothelial Decompensation with Coexistent Aphakia or Intra Ocular Lens Subluxation

Annals of the National Academy of Medical Sciences (India) ◽

10.1055/s-0041-1739036 ◽

2021 ◽

Author(s):

Jaya Kaushik ◽

Ankita Singh ◽

Rakesh Shetty ◽

Jitendra Kumar Singh Parihar ◽

Divya Kochhar ◽

...

Keyword(s):

Visual Acuity ◽

Visual Outcome ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Ocular Lens ◽

Descemet Stripping Endothelial Keratoplasty ◽

Lens Subluxation ◽

Preoperative Visual Acuity ◽

Endothelial Decompensation

Abstract Purpose To elucidate visual outcome of patients after combined Descemet stripping endothelial keratoplasty (DSEK) with scleral fixated intra ocular lens (SFIOL) implantation in patients of endothelial decompensation with coexistent aphakia or lens subluxation. Materials and Methods A prospective interventional study of combined DSEK with sutured SFIOL in the patients who have undergone surgery at our center over 6-month follow-up period. Preoperative visual acuity and slit lamp findings were documented. Postoperative follow-up was done at days 1, 3, and 7 subsequently, months 1 and 3, and thereafter monthly till the sixth month. Results Mean age of the patients was 60.47 years. Six patients had aphakic bullous keratopathy, while 11 patients had pseudophakic bullous keratopathy with subluxated posterior chamber IOL (PCIOL). Preoperative visual acuity ranged from hand movements close to face (LogMar 2.4) with accurate projection of rays to 1/60 (LogMar 2) due to existing corneal edema and aphakia. Postoperatively uncorrected visual acuity at 6 months improved up to 6/36 (LogMar 0.8) in all cases. There was gradual improvement in corneal clarity and compactness during the follow-up. A good donor tissue endothelial count and an adequate IOP control were vital prognostic factors for the successful outcome. Conclusion This novel surgical merger reduces the complications of lenticule dislocation into vitreous and repeated surgeries and shows results akin to when performed in a staged manner.

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Surgical management of suprasellar meningioma

Journal of Neurosurgery ◽

10.3171/jns.1984.61.4.0642 ◽

1984 ◽

Vol 61 (4) ◽

pp. 642-648 ◽

Cited By ~ 72

Author(s):

Jacob Rosenstein ◽

Lindsay Symon

Keyword(s):

Tumor Size ◽

Visual Loss ◽

Visual Fields ◽

Visual Outcome ◽

Duration Of Symptoms ◽

Content Type ◽

Before And After ◽

Funduscopic Examination ◽

Optic Discs ◽

Fine Print

✓ Visual outcome in 101 consecutive cases of suprasellar meningioma treated over a 35-year period has been examined. Preoperative visual loss was evaluated using a scoring system that takes both visual acuity and visual fields into account. In this way a percentage visual loss was calculated for each patient before and after surgery. The effects on visual outcome of age, preoperative visual loss, duration of visual symptoms, tumor size, status of the optic disc, and binocular versus monocular involvement was examined. For the group as a whole, vision improved in 63 patients, was unchanged in 12 patients, and was worse in 24 patients. Prognosis was favorably affected by a mean duration of symptoms of less than 2 years, a tumor size of less than 3 cm, a preoperative visual loss of less than 50%, and the presence of normal optic discs on funduscopic examination. Age had some effect on prognosis, but the presence of binocular or monocular involvement had no effect.

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Xtra focus pinhole IOL (Morchers GMBH) a novel approach to tackle irregular astigmatism and large pupillary defects with a single step surgery

BMJ Case Reports ◽

10.1136/bcr-2018-228902 ◽

2019 ◽

Vol 12 (4) ◽

pp. e228902 ◽

Cited By ~ 1

Author(s):

Prateek Agarwal ◽

Samuel Edward Navon

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Intraocular Lens ◽

Visual Outcome ◽

Single Step ◽

Novel Approach ◽

Uncorrected Distance Visual Acuity ◽

Uncorrected Visual Acuity ◽

Corneal Scar ◽

History Of

A 69-year-old patient presented to us with traumatic mydriasis with irregular pupil measuring 7 mm, with superior loss of iris tissue and large inferior peripheral iridotomy and pseudophakia. The patient had history of blunt trauma 3 years ago in a fire cracker injury. He was operated elsewhere primarily after the trauma for cataract surgery with intraocular lens implantation and had suboptimal visual outcome with glare and photophobia. He presented to us with irregular pupil and inferior iridectomy with pseudophakia. The uncorrected visual acuity was 20/150 improving to 20/50 with glasses. He had a history of cataract surgery with intraocular lens (IOL) implantation done elsewhere several years back. The patient was not a diabetic or hypertensive. There was a para central corneal scar causing irregular corneal astigmatism. Extra focus pinhole IOL was implanted in sulcus having a pinhole aperture 1.36 mm. Preoperative total corneal higher-order aberrations were 3.3 µ and total corneal coma was 0.97 µ. Postoperatively uncorrected distance visual acuity improved to 20/40 intermediate uncorrected visual acuity improved to 20/30 and uncorrected near visual acuity was J3.

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Prognostic significance of intraoperative change in the fractional anisotropy and the volume of the optic chiasma during resection of suprasellar tumors

Journal of Neurosurgery ◽

10.3171/2016.12.jns162741 ◽

2018 ◽

Vol 128 (5) ◽

pp. 1479-1485 ◽

Cited By ~ 1

Author(s):

Hussam Metwali ◽

Mario Giordano ◽

Katja Kniese ◽

Rudolf Fahlbusch

Keyword(s):

Fractional Anisotropy ◽

Prognostic Significance ◽

Tumor Resection ◽

Visual Outcome ◽

Significant Negative Correlation ◽

Strongly Correlated ◽

Duration Of Symptoms ◽

Optic Chiasma ◽

Early Predictors ◽

Impairment Score

OBJECTIVEThe aim of this study was to test the prognostic significance of intraoperative changes in the fractional anisotropy (FA) and the volume of the optic chiasma and their correlation with visual outcome.METHODSTwenty-eight sequential patients with suprasellar tumors presenting with chiasma compression syndrome were surgically treated under intraoperative MRI control between March 2014 and July 2016. The FA and the volume of the optic chiasma were measured immediately before and immediately after tumor resection. The visual impairment score (VIS) was used to quantify the severity of the ophthalmological disturbances before surgery, 10–14 days after surgery, and again 3 months thereafter. The change in the FA and the volume of the optic chiasma was correlated to the improvement of vision. The correlation between other predictors such as the age of the patients and the duration of symptoms and the visual outcome was tested.RESULTSThe VIS improved significantly after surgery. The FA values of the optic chiasma decreased significantly after decompression, whereas the volume of the optic chiasma increased significantly after decompression. The early and delayed improvement of vision was strongly correlated to the decrease in the average FA and the increase of the volume of the optic chiasma. The duration of symptoms showed a significant negative correlation to the visual outcome. However, the decrease in the FA showed the strongest correlation to the improvement of the VIS, followed by the expansion of the optic chiasma, and then the duration of symptoms.CONCLUSIONSThe decrease in the FA and the expansion of the optic chiasma after its decompression are strong early predictors of the visual outcome. These parameters are also able to predict delayed improvement of vision.

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Management of cataract in a case of retinitis pigmentosa with bilateral pseudoexfoliation syndrome

BMJ Case Reports ◽

10.1136/bcr-2020-238936 ◽

2021 ◽

Vol 14 (2) ◽

pp. e238936

Author(s):

Sucheta Parija ◽

Koyel Chakraborty

Keyword(s):

Visual Acuity ◽

Retinitis Pigmentosa ◽

Cataract Surgery ◽

Intraocular Lens ◽

Visual Outcome ◽

Pseudoexfoliation Syndrome ◽

Corrected Distance Visual Acuity ◽

History Of ◽

Hypertensive Woman ◽

The Right

Retinitis pigmentosa (RP) patients are at higher risk for macular oedema, anterior capsular phimosis and spontaneous dislocation of the implanted lens after cataract surgery. A 70-year-old hypertensive woman presented with diminution of vision in her left eye since 2 years. She had history of cataract surgery in the right eye 1 year ago. Her visual acuity was 20/200 in right eye and hand movements in left eye. Slit-lamp examination showed anterior capsular phimosis with intraocular lens in the right eye and pseudoexfoliation in both the eyes. Fundus examination revealed features of RP in both the eyes. Optical coherence tomography showed bilateral foveal atrophy. The patient underwent phacoemulsification cataract surgery with intraocular lens implantation in left eye and Nd:YAG laser capsulotomy in right eye. Postoperative best corrected distance visual acuity was 20/125 in right eye and 20/80 in left eye. This case highlights a rare coincidence of pseudoexfoliation syndrome in a patient with RP and the precautions undertaken during cataract surgery for an optimal visual outcome.

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