Outcome of visual acuity after surgical removal of pituitary adenomas

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.

Download Full-text

Prognostic factors for postoperative visual outcome in surgically treated suprasellar meningiomas

Medicinski pregled ◽

10.2298/mpns1606146g ◽

2016 ◽

Vol 69 (5-6) ◽

pp. 146-152 ◽

Cited By ~ 2

Author(s):

Desanka Grkovic ◽

Sofija Davidovic

Keyword(s):

Visual Acuity ◽

Tumor Size ◽

Visual Function ◽

Tumor Resection ◽

Visual Outcome ◽

Duration Of Symptoms ◽

Postoperative Visual Acuity ◽

Preoperative Visual Acuity ◽

History Of ◽

Meningioma Surgery

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.

Download Full-text

Peeling of Epiretinal Membrane: Analysis of Prognostic Factors and Surgical Complications, Impacting Visual Outcome

10.5772/intechopen.101490 ◽

2021 ◽

Author(s):

Tatyana Beketova ◽

Gennady Landa

Keyword(s):

Visual Acuity ◽

Prognostic Factors ◽

Epiretinal Membrane ◽

Fundus Autofluorescence ◽

Visual Outcome ◽

Ganglion Cell Complex ◽

Duration Of Symptoms ◽

First Line Therapy ◽

Macular Holes ◽

Retinal Breaks

An epiretinal membrane (ERM) is the most common pathology of the vitreoretinal interface. First-line therapy for a symptomatic ERM is vitrectomy with ERM peeling. Clinical prognostic factors for postoperative visual acuity improvement include baseline visual acuity, age, duration of symptoms, and baseline pseudophakia. Postoperative optical coherence tomography (OCT) shows improvement in the integrity of the inner/outer segment junction and a reduction in the thickness of the ganglion cell complex and foveola. Retinal changes after ERM peel are also described using OCT angiography, fluorescein angiography, fundus autofluorescence, and multifocal retinography. Complications of ERM peeling include cataract formation, retinal breaks/detachments, ERM recurrence, and macular holes.

Download Full-text

Anatomical and functional significance of ectopic inner foveal layer (EIFL) in epiretinal membrane (ERM)

Indian Journal of Clinical and Experimental Ophthalmology ◽

10.18231/j.ijceo.2021.072 ◽

2021 ◽

Vol 7 (2) ◽

pp. 366-371

Author(s):

Sunil Ganekal ◽

Varun Ganekal

Keyword(s):

Visual Acuity ◽

Epiretinal Membrane ◽

Visual Outcome ◽

Surgical Removal ◽

Chi Square ◽

Epiretinal Membranes ◽

Stage 4 ◽

Before And After ◽

Chi Square Test ◽

Stage 1

To compare the visual acuity outcomes after surgical treatment of epiretinal membranes (ERM) in cases with and without ectopic inner foveal layers (EIFL). : A total of 100 eyes of 98 patients with idiopathic ERM were retrospectively staged according to the newer OCT classification and divided into two groups on the basis of presence or absence of EIFL. The two groups were evaluated for various parameters including visual acuity, thickness of the EIFL, re-appearance of the foveal contour, outer retinal changes and complications before and after ERM peeling. Correlation analysis was done using chi square test and p-values were obtained for corresponding variables.: Of 100 eyes with ERM, 20% had stage 1, 29% had stage 2, 42% had stage3 & 9% had stage 4 disease. VA was worse in eyes with EIFL as compared those without it. Correlation of VA with EIFL thickness however was not significant. Surgical removal of ERM didn’t alter EIFL frequency though the thickness decreased. New EIFL appeared in 4% eyes and 35% demonstrated thickened fovea after surgery. Anatomical reappearance of foveal contour was poorer in eyes with EIFL. Outer retinal changes were more common in non EIFL eyes. Lamellar holes and nontractional cysts were more common in EIFL eyes.: EIFL is a significant prognostic tool to predict the visual outcome of surgery in cases of Epiretinal membrane. EIFL eyes did not regain foveal contour, had less outer retinal damage but were associated with poorer visual outcomes.

Download Full-text

Extended transsphenoidal approach for pituitary adenomas invading the anterior cranial base, cavernous sinus, and clivus: a single-center experience with 126 consecutive cases

Journal of Neurosurgery ◽

10.3171/2009.3.jns0929 ◽

2010 ◽

Vol 112 (1) ◽

pp. 108-117 ◽

Cited By ~ 49

Author(s):

Bing Zhao ◽

Yu-Kui Wei ◽

Gui-Lin Li ◽

Yong-Ning Li ◽

Yong Yao ◽

...

Keyword(s):

Postoperative Complications ◽

Cavernous Sinus ◽

Pituitary Adenomas ◽

Tumor Resection ◽

Cranial Base ◽

Transsphenoidal Approach ◽

Preoperative Imaging ◽

Surgical Removal ◽

Extended Transsphenoidal Approach ◽

Anterior Cranial Base

Object The standard transsphenoidal approach has been successfully used to resect most pituitary adenomas. However, as a result of the limited exposure provided by this procedure, complete surgical removal of pituitary adenomas with parasellar or retrosellar extension remains problematic. By additional bone removal of the cranial base, the extended transsphenoidal approach provides better exposure to the parasellar and clival region compared with the standard approach. The authors describe their surgical experience with the extended transsphenoidal approach to remove pituitary adenomas invading the anterior cranial base, cavernous sinus (CS), and clivus. Methods Retrospective analysis was performed in 126 patients with pituitary adenomas that were surgically treated via the extended transsphenoidal approach between September 1999 and March 2008. There were 55 male and 71 female patients with a mean age of 43.4 years (range 12–75 years). There were 82 cases of macroadenoma and 44 cases of giant adenoma. Results Gross-total resection was achieved in 78 patients (61.9%), subtotal resection in 43 (34.1%), and partial resection in 5 (4%). Postoperative complications included transient cerebrospinal rhinorrhea (7 cases), incomplete cranial nerve palsy (5), panhypopituitarism (5), internal carotid artery injury (2), monocular blindness (2), permanent diabetes insipidus (1), and perforation of the nasal septum (2). No intraoperative or postoperative death was observed. Conclusions The extended transsphenoidal approach provides excellent exposure to pituitary adenomas invading the anterior cranial base, CS, and clivus. This approach enhances the degree of tumor resection and keeps postoperative complications relatively low. However, radical resection of tumors that are firm, highly invasive to the CS, or invading multidirectionally remains a big challenge. This procedure not only allows better visualization of the tumor and the neurovascular structures but also provides significant working space under the microscope, which facilitates intraoperative manipulation. Preoperative imaging studies and new techniques such as the neuronavigation system and the endoscope improve the efficacy and safety of tumor resection.

Download Full-text

Clinical features and treatment outcomes of endogenous Klebsiella endophthalmitis: a 12-year review

International Journal of Ophthalmology ◽

10.18240/ijo.2020.12.14 ◽

2020 ◽

Vol 13 (12) ◽

pp. 1933-1940

Author(s):

Chun Yue Mak ◽

Lawrence Pui-leung Iu ◽

Helena Pui-yee Sin ◽

Li Jia Chen ◽

Grace Lui ◽

...

Keyword(s):

Visual Acuity ◽

Prognostic Factors ◽

Treatment Outcomes ◽

Clinical Features ◽

Visual Outcome ◽

Ophthalmological Examination ◽

Poor Visual Outcome ◽

Ocular Symptoms ◽

Clinical Records ◽

High Index Of Suspicion

AIM: To identify the clinical features and treatment outcomes of endogenous Klebsiella pneumoniae endophthalmitis and investigate prognostic factors of poor visual outcome. METHODS: The clinical records of all patients diagnosed with endogenous Klebsiella endophthalmitis between January 2007 to December 2018 in Prince of Wales Hospital, Hong Kong, China were retrospectively reviewed. Thorough ophthalmological examination findings were recorded in the case note, including visual acuity testing, slit-lamp examination, indirect ophthalmoscopy and B-scan ultrasonography if media opacity precluded fundus viewing. RESULTS: A total of 18 eyes in 14 patients were identified. Bilateral involvement was noted in 4 patients (28.6%). Hepatobiliary sepsis was the source in 9 patients (64.3%). Culture of intraocular fluid was positive in 5 out of 18 eyes (27.8%). Mortality was noted in 2 patients (14.3%). Mean final visual acuity was 20/1500. Six out of 16 eyes had total loss of sight (37.5%) and 3 eyes required evisceration (18.8%). Multivariate linear regression revealed poor presenting visual acuity (P=0.031) and lack of fundus view due to vitritis (P=0.02) as prognostic factors of poor visual outcome. CONCLUSION: Visual outcome of endogenous Klebsiella endophthalmitis is poor. Poor presenting visual acuity and lack of fundus view predict poor visual outcome. High index of suspicion for endophthalmitis is important in Klebsiella sepsis patients with complaints of ocular symptoms. Ophthalmological screening is recommended in non-communicable patients with Klebsiella sepsis.

Download Full-text

Prognostic Factors for Low Visual Acuity after Cataract Surgery with Vitreous Loss

Journal of Ophthalmology ◽

10.1155/2021/6691904 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Michael Mimouni ◽

Michal Schaap-Fogler ◽

Philip Polkinghorne ◽

Gilad Rabina ◽

Rita Ehrlich

Keyword(s):

Visual Acuity ◽

Prognostic Factors ◽

Cataract Surgery ◽

Intraocular Lens ◽

Axial Length ◽

Visual Outcome ◽

Multivariable Logistic Regression Analysis ◽

Iol Implantation ◽

Secondary Iol Implantation ◽

Vitreous Loss

Purpose. The purpose of this study is to find prognostic factors associated with low visual acuity in patients experiencing vitreous loss during cataract surgery. Methods. A retrospective, noncomparative, interventional, case study of patients experiencing vitreous loss during cataract surgery. Data collected included demographics, best corrected visual acuity (BCVA), axial length (AL), presence of ocular comorbidity affecting central vision, timing of intraocular lens (IOL) implantation, position of the implanted lens, and the presence of corneal sutures. Low visual outcome was defined as BCVA < 20/40. Results. Overall, 179 patients (60.3% males) with a mean age of 73 ± 12 years and axial length of 23.5 ± 1.3 mm with a mean follow-up of 12 ± 13 months were included. In multivariable logistic regression analysis, low visual outcome was independently associated with persisting postoperative complications (OR 6.25, 95% CI 1.378–30.9), preexisting ocular comorbidities (OR 4.45, 95% CI 1.1–18.00), and secondary intraocular lens (IOL) implant (OR 10.36, 95% CI 1.8–60.00). Conversely, pars plana vitrectomy (PPV) for dislocated fragments of lens material, age > 70 years, gender, axial length, degree of surgeon, corneal suturing, and anterior chamber lens implantation were not found to have significant associations with low visual outcomes ( P > 0.05 ). Conclusions. Low visual outcome after vitreous loss during cataract surgery was associated with ocular comorbidities, secondary IOL implantation, development of cystoid macular edema, and additional surgical complications.

Download Full-text

Intraocular Foreign Bodies: Clinical Characteristics and Prognostic Factors Influencing Visual Outcome and Globe Survival in 373 Eyes

Journal of Ophthalmology ◽

10.1155/2019/5208092 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Yang Liu ◽

Shuang Wang ◽

Ying Li ◽

Qiaoyun Gong ◽

Guanfang Su ◽

...

Keyword(s):

Visual Acuity ◽

Prognostic Factors ◽

Clinical Characteristics ◽

Foreign Bodies ◽

Vitreous Hemorrhage ◽

Visual Outcome ◽

Ocular Injury ◽

Factors Influencing ◽

Retinal Breaks ◽

Wound Length

Aim. To describe epidemiologic and clinical characteristics and prognostic factors influencing visual outcome after intraocular foreign bodies (IOFBs) injury. Methods. Medical records of 370 patients (373 eyes) with IOFBs were reviewed to identify the factors influencing visual acuity by univariate and multivariate analyses. Results. The majority of patients (97.0%) were men, with a mean age of 38.1 years. The most common cause of ocular injury was hammering (52.6%); magnetic IOFBs occurred in 84.7% of these cases. Factors associated with poor visual outcome (defined as <1.3 logMAR) included the following: age ≥50 years (P=0.046); worse presenting visual acuity (P<0.001); complications of retinal breaks (P=0.006) and endophthalmitis (P=0.032); vitrectomy (P=0.035); and intraocular C3F8 gas tamponade (P=0.038). Excellent visual outcome (defined as ≥0.5 logMAR) was associated with age <50 years (P=0.003); better presenting visual acuity (PVA) (P<0.001); wound length <4 mm (P=0.005); absence of vitreous hemorrhage (P=0.026) and retinal breaks (P<0.001); nonvitrectomy surgery (P=0.043); and use of balanced saline (P=0.029). Conclusions. Multiple prognostic factors were identified that may predict visual outcome and globe survival after IOFBs injury. Age, initial presenting visual acuity, wound length, complications (vitreous hemorrhage, retinal breaks, and endophthalmitis), surgical approach, and intraocular tamponade were significant predictors of visual outcome.

Download Full-text

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.

Download Full-text

Endoscopic endonasal versus transcranial approach to tuberculum sellae and planum sphenoidale meningiomas in a similar cohort of patients

Journal of Neurosurgery ◽

10.3171/2016.9.jns16823 ◽

2018 ◽

Vol 128 (1) ◽

pp. 40-48 ◽

Cited By ~ 38

Author(s):

Evan D. Bander ◽

Harminder Singh ◽

Colin B. Ogilvie ◽

Ryan C. Cusic ◽

David J. Pisapia ◽

...

Keyword(s):

Tumor Size ◽

Visual Outcome ◽

Optic Chiasm ◽

Extent Of Resection ◽

Surgical Removal ◽

Endoscopic Endonasal ◽

Csf Leakage ◽

Transcranial Approach ◽

Tuberculum Sellae ◽

Planum Sphenoidale

OBJECTIVEPlanum sphenoidale (PS) and tuberculum sellae (TS) meningiomas cause visual symptoms due to compression of the optic chiasm. The treatment of choice is surgical removal with the goal of improving vision and achieving complete tumor removal. Two options exist to remove these tumors: the transcranial approach (TCA) and the endonasal endoscopic approach (EEA). Significant controversy exists regarding which approach provides the best results and whether there is a subset of patients for whom an EEA may be more suitable. Comparisons using a similar cohort of patients, namely, those suitable for gross-total resection with EEA, are lacking from the literature.METHODSThe authors reviewed all cases of PS and TS meningiomas that were surgically removed at Weill Cornell Medical College between 2000 and 2015 (TCA) and 2008 and 2015 (EEA). All cases were shown to a panel of 3 neurosurgeons to find only those tumors that could be removed equally well either through an EEA or TCA to standardize both groups. Volumetric measurements of preoperative and postoperative tumor size, FLAIR images, and apparent diffusion coefficient maps were assessed by 2 independent reviewers and compared to assess extent of resection and trauma to the surrounding brain. Visual outcome and complications were also compared.RESULTSThirty-two patients were identified who underwent either EEA (n = 17) or TCA (n = 15). The preoperative tumor size was comparable (mean 5.58 ± 3.42 vs 5.04 ± 3.38 cm3 [± SD], p = 0.661). The average extent of resection achieved was not significantly different between the 2 groups (98.80% ± 3.32% vs 95.13% ± 11.69%, p = 0.206). Postoperatively, the TCA group demonstrated a significant increase in the FLAIR/edema signal compared with EEA patients (4.15 ± 7.10 vs −0.69 ± 2.73 cm3, p = 0.014). In addition, the postoperative diffusion-weighted imaging signal of cytotoxic ischemic damage was significantly higher in the TCA group than in the EEA group (1.88 ± 1.96 vs 0.40 ± 0.55 cm3, p =0.008). Overall, significantly more EEA patients experienced improved or stable visual outcomes compared with TCA patients (93% vs 56%, p = 0.049). Visual deterioration was greater after TCA than EEA (44% vs 0%, p = 0.012). While more patients experienced postoperative seizures after TCA than after EEA (27% vs 0%, p = 0.038), there was a trend toward more CSF leakage and anosmia after EEA than after TCA (11.8% vs 0%, p = 0.486 and 11.8% vs 0%, p = 0.118, respectively).CONCLUSIONSIn this small single-institution study of similarly sized and located PS and TS meningiomas, EEA provided equivalent rates of resection with better visual results, less trauma to the brain, and fewer seizures. These preliminary results merit further investigation in a larger multiinstitutional study and may support EEA resection by experienced surgeons in a subset of carefully selected PS and TS meningiomas.

Download Full-text

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.

Download Full-text