Arteriovenous malformations in the optic apparatus: systematic literature review and report of four cases

OBJECTIVE Rare arteriovenous malformations (AVMs) of the optic apparatus account for < 1% of all AVMs. The authors conducted a systematic review of the literature for cases of optic apparatus AVMs and present 4 cases from their institution. The literature is summarized to describe preoperative characteristics, surgical technique, and treatment outcomes for these lesions. METHODS A comprehensive search of the English-language literature was performed in accordance with established Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all published cases of AVM in the optic apparatus in the PubMed, Web of Science, and Cochrane databases. The authors also searched their prospective institutional database of vascular malformations for such cases. Data regarding the clinical and radiological presentation, visual acuity, visual fields, extent of resection, and postoperative outcomes were gathered. RESULTS Nine patients in the literature and 4 patients in the authors’ single-surgeon series who fit the inclusion criteria were identified. The median age at presentation was 29 years (range 8–39 years). Among these patients, 11 presented with visual disturbance, 9 with headache, and 1 with multiple prior subarachnoid hemorrhages; the AVM in 1 case was found incidentally. Four patients described prior symptoms of headache or visual disturbance consistent with sentinel events. Visual acuity was decreased from baseline in 10 patients, and 11 patients had visual field defects on formal visual field testing. The most common visual field defect was temporal hemianopia, found in one or both eyes in 7 patients. The optic chiasm was affected in 10 patients, the hypothalamus in 2 patients, the optic nerve (unilaterally) in 8 patients, and the optic tract in 2 patients. Six patients underwent gross-total resection; 6 patients underwent subtotal resection; and 1 patient underwent craniotomy, but no resection was attempted. Postoperatively, 9 of the patients had improved visual function, 1 had no change, and 3 had worse visual acuity. Eight patients demonstrated improved visual fields, 1 had no change, and 4 had narrowed fields. CONCLUSIONS AVMs of the optic apparatus are rare lesions. Although they reside in a highly eloquent region, surgical outcomes are generally good; the majority of patients will see improvement in their visual function postoperatively. Microsurgical technique is critical to the successful removal of these lesions, and preservation of function sometimes requires subtotal resection of the lesion.

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Visual Field Defect after Cardiac Surgery: The Striking Role of Interdisciplinary Collaboration

Case Reports in Ophthalmological Medicine ◽

10.1155/2015/904528 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Raffaele Nuzzi ◽

Carlo Lavia

Keyword(s):

Visual Acuity ◽

Visual Field ◽

Interdisciplinary Collaboration ◽

Visual Fields ◽

Cortical Blindness ◽

Visual Field Defects ◽

Ischemic Optic Neuropathy ◽

Intraoperative Hypotension ◽

Perioperative Visual Loss ◽

Vascular Occlusions

Perioperative visual loss (POVL) is a potentially devastating complication that can occur following ocular or nonocular surgery. The leading causes of this disease are retinal vascular occlusions, ischemic optic neuropathies, and cortical blindness. POVL pathogenesis is strictly influenced by surgery, anesthesia, and patients’ comorbidities. We report of a 55-year-old caucasian man who presented with complaints of sudden painless loss of vision and unilateral campimetric deficit. We recorded a preserved visual acuity but at fundus examination a bilateral ischemic optic neuropathy (ION) was suspected. Our hypothesis was supported by uncommon and peculiar visual field defects and a history of cardiovascular surgery shortly before was a striking data. When we examined his medical records we found strong accordance with what is reported in literature to be risk factors for postoperative ION development. He presented intraoperative hypotension, anemia, and hypothermia, he was older than 50 years, and surgery lasted for more than five hours. We are currently monitoring his visual acuity and visual fields which remain unchanged. As there is no proved therapy for such severe adverse events, we recommend intraoperative check of blood pressure, blood loss, and body temperature, associated with repeated eye checks and patients’ interview.

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Edema of the optic tract in patients with tumors of the sellar region: clinical and visual implications in the pediatric population

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.11.peds17526 ◽

2018 ◽

Vol 21 (5) ◽

pp. 516-522 ◽

Cited By ~ 3

Author(s):

Aurore Bussat ◽

Maia Proisy ◽

Bertrand Bruneau ◽

Guillaume Bouzillé ◽

Céline Chappé ◽

...

Keyword(s):

Visual Acuity ◽

Visual Field ◽

Visual Function ◽

Clinical Symptoms ◽

Pediatric Population ◽

Optic Tract ◽

Final Examination ◽

Sellar Region ◽

Treatment Type ◽

Number Of Patients

OBJECTIVETumor-related edema of the optic tract (EOT) corresponds to a preferential posterior distribution of peritumoral edema along the white matter tract of the visual system. To date, the consequences of EOT have never been evaluated specifically in the pediatric population. In this study, the authors attempted to identify clinical and radiological features associated with the development of EOT and the specific influence of this edema on visual function.METHODSA retrospective review was performed of data collected from patients younger than 18 years who underwent surgery for a tumor in the sellar region at the authors’ institution between January 2005 and January 2016. Data were collected on patient characteristics, ophthalmological evaluations, and neuroimaging findings. To evaluate and compare visual function impairment, ophthalmological data were converted to a global visual function score, which took into account visual acuity, visual field evaluations, and laterality deficiencies. The visual acuity score was defined according to the International Classification of Diseases, 10th Revision. Visual field deficiencies were converted to a score of 0–2. Two opposing groups were then distinguished according to the presence or absence of EOT. Visual acuity, visual field results, and global scores were compared between groups before and after treatment.RESULTSTwenty-six patients were included in the study: 17 patients with craniopharyngioma, 3 patients with pilocytic astrocytoma, 2 patients with ganglioglioma, 2 patients with germ cell tumor, 1 patient with macroprolactinoma, and 1 patient with Rathke’s cleft cyst. There were 11 children in the group with edema and 15 children in the group without edema. None of the following criteria were statistically different between the 2 groups: age, sex, clinical symptoms at presentation (endocrine deficiency or intracranial hypertension signs), incidence of hydrocephalus, compression of the optic tracts and mass effect on the optic chiasm, tumor size and localization, presence of intratumoral cysts, treatment, type of tumor, or recurrence. The median global visual function and visual acuity scores were not significantly different between the groups either at presentation or at final evaluation. The visual field score was lower (i.e., more deficiency) in the group with edema than in the group without edema (p < 0.05); 89% of the patients with edema had severe or mild visual field impairment versus only 40% of the patients without edema. At the final examination after treatment, the visual field scores were not different between the 2 groups. Although not significant, the number of patients with optic disc pallor was greater in the group without edema both at diagnosis and at final examination.CONCLUSIONSThis study confirms that EOT in the context of sellar region tumor in children is not necessarily associated with a less-favorable visual prognosis.

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A novel scale for describing visual outcomes in patients following resection of lesions affecting the optic apparatus: the Unified Visual Function Scale

Journal of Neurosurgery ◽

10.3171/2017.6.jns17707 ◽

2018 ◽

Vol 129 (6) ◽

pp. 1438-1445

Author(s):

Serge Makarenko ◽

Vincent Ye ◽

Peter A. Gooderham ◽

Ryojo Akagami

Keyword(s):

Visual Acuity ◽

Visual Field ◽

Visual Function ◽

Tumor Resection ◽

Visual Fields ◽

Case Series ◽

Relevant Information ◽

Treatment Groups ◽

Visual Outcomes ◽

User Friendly

OBJECTIVEHistorically, descriptions of visual acuity and visual field change following intracranial procedures have been very rudimentary. Clinicians and researchers have often used basic descriptions, such as “improved,” “worsened,” and “unchanged,” to describe outcomes following resections of tumors affecting the optic apparatus. These descriptors are vague, difficult to quantify, and challenging to apply in a clinical perspective. Several groups have attempted to combine visual acuity and visual fields into a single assessment score, but these are not user-friendly. The authors present a novel way to describe a patient’s visual function as a combination of visual acuity and visual field assessment that is simple to use and can be used by surgeons and researchers to gauge visual outcomes following tumor resection.METHODSVisual acuity and visual fields were combined into 3 categories designed around the definitions of legal blindness and fitness to drive in Canada. The authors then applied the scale (the Unified Visual Function Scale, or UVFS) to their previously published case series of perisellar meningiomas to document and test overall visual outcomes for patients undergoing tumor resection. The results were compared with previously documented visual loss scales in the literature.RESULTSUsing the UVFS the authors were able to capture the overall visual change; the scale was sensitive enough to define the overall visual improvement or worsening quantitatively, using categories that are clinically relevant and understandable.CONCLUSIONSThe UVFS is a robust way to assess a patient’s vision, combining visual fields and acuity. The implementation of pre- and postoperative assessment is sensitive enough to assess overall change while also providing clinically relevant information for surgeons, and allows for comparisons between treatment groups.

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Migraine-Like Positive Visual Phenomena Related to Focal Cortical Lesions with Undetectable Visual Field Defects

Case Reports in Ophthalmology ◽

10.1159/000517792 ◽

2021 ◽

pp. 653-658

Author(s):

Amir Vosoughi ◽

Andrew Micieli ◽

Jonathan A. Micieli

Keyword(s):

Visual Field ◽

Visual Fields ◽

Occipital Lobe ◽

Visual Disturbance ◽

Visual Field Defects ◽

Cortical Lesions ◽

Visual Aura ◽

Visual Phenomena ◽

History Of ◽

Field Defects

Migraines are commonly associated with a visual aura that has a characteristic clinical presentation. Cortical lesions within or in close proximity to the retrochiasmal visual pathways may also present in a manner that mimics migrainous visual phenomena and, in some cases, may be too small to manifest with a visual field defect on formal testing. We present 4 patients (3 females and 1 male) with an average age of 48.5 (range 28–67) years who had migraine-like visual disturbances related to a right temporal meningioma, occipital cavernoma, occipital lobe infarction, and demyelination in the optic radiations, which was the presenting sign of multiple sclerosis. No patient underwent neurosurgical intervention, and 1 patient (occipital lobe infarct) had complete resolution of the symptom after initial presentation. All patients had normal visual fields at follow-up and no thinning evident on optical coherence tomography. Our cases emphasize the importance of a history in assessing patients with transient positive visual phenomena and identify pathology that may present without visual field defects. Clinical features that should raise a doubt about a diagnosis of migraine visual aura include the absence of headache, brief visual disturbance lasting <5 min or those lasting >60 min, and age >40, especially with no past medical history of migraine.

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Visual Fields

10.1093/oso/9780195389685.001.0001 ◽

2010 ◽

Cited By ~ 1

Keyword(s):

Visual Field ◽

Visual Fields ◽

Optic Tract ◽

Optic Chiasm ◽

Visual Field Defects ◽

Clinical Aspects ◽

Automated Perimetry ◽

Visual Field Examination ◽

Eye Disorders ◽

Field Defects

Visual Fields: Examination and Interpretation, 3rd edition contains revisions and updates of earlier material as well as a discussion of newer techniques for assessing visual field disorders. The book begins with a short history of the field of perimetry and goes on to present basic clinical aspects of examination and diagnosis of visual field defects in the optic nerve, optic disc, chorioretina, optic chiasm, optic tract, lateral geniculate field bodies, and the calcarine complex. Additional aspects of visual field examination are explored including those of monocular, binocular, and junctional field defects, congruity vs. incongruity, macular sparing vs. macular splitting, density, wedge-shaped homonymous field loss, and monocular temporal crescent. Various new techniques of automated perimetry are also considered including SITA, FASTPAC, and SWAP. This volume provides a very useful overview of the techniques of visual field examination in a number of eye disorders and will be of interest to all ophthalmologists, neuro-opthalmologists, retina specialists, and optometrists.

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Visual Recovery after Transsphenoidal Removal of Pituitary Adenomas

Neurosurgery ◽

10.1227/00006123-198509000-00008 ◽

1985 ◽

Vol 17 (3) ◽

pp. 446-452 ◽

Cited By ~ 111

Author(s):

Alan R. Cohen ◽

Paul R. Cooper ◽

Mark J. Kupersmith ◽

Eugene S. Flamm ◽

Joseph Ransohoff

Keyword(s):

Visual Acuity ◽

Visual Field ◽

Diabetes Insipidus ◽

Pituitary Adenomas ◽

Visual Fields ◽

Visual Field Defects ◽

Duration Of Symptoms ◽

Patients Âgés ◽

Cerebrospinal Fluid Rhinorrhea ◽

Field Defects

Abstract We reviewed the records of 100 consecutive patients with histologically verified pituitary adenomas who underwent transsphenoidal decompression of the optic nerves and chiasm. The patients' ages ranged from 18 to 80 years, with a median of 52 years. Preoperatively, all patients had objective signs of visual acuity or field defects. Postoperatively, visual acuity was normal or improved in 79% of the eyes and the visual fields were normal or improved in 74%. The visual outcome (for both acuity and fields) was better in younger patients and those with a shorter duration of symptoms. Patients with lesser degrees of preoperative visual acuity compromise had better postoperative visual acuity outcome. However, the severity of preoperative visual field defects did not seem to predict postoperative field outcome, and even patients with severe preoperative field defects often had striking postoperative improvement. Patients who had undergone prior operation were less likely to have either visual acuity or visual field improvement after reoperation. Postoperative deterioration in visual acuity was noted in only 5 patients (6 eyes). Complications were few. There were 4 instances of cerebrospinal fluid rhinorrhea, but only 2 patients needed operative repair. There was no instance of permanent diabetes insipidus, although 17 patients developed transient diabetes insipidus. In most cases, visual improvement was sustained. The average duration of follow-up was 26 months. Three patients required a subsequent operation to correct visual loss in the immediate postoperative period, but only 1 patient has undergone late operation for recurrence of tumor. There was no operative mortality.

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Distracted Driving and Driving Patterns in Older Drivers With Glaucoma

American Journal of Lifestyle Medicine ◽

10.1177/15598276211042825 ◽

2021 ◽

pp. 155982762110428

Author(s):

Purva Jain ◽

Jonathan T. Unkart ◽

Fabio B. Daga ◽

Linda Hill

Keyword(s):

Visual Acuity ◽

Visual Field ◽

Visual Fields ◽

Distracted Driving ◽

Night Vision ◽

Driving Ability ◽

Safe Driving ◽

Ability To Drive ◽

Acuity Score

Limited research exists examining self-perceived vision and driving ability among individuals with glaucoma, and this study assessed the relationship between glaucoma, visual field, and visual acuity with driving capability. 137 individuals with glaucoma and 75 healthy controls were asked to evaluate self-rated vision, self-perceived driving ability, and self-perceived distracted driving. Visual acuity and visual field measurements were also obtained. Multivariable linear regressions were run to test each visual measure with driving outcomes. The average age was 72.2 years, 57.3% were male, and 72.5% were White. There were significant associations for a one-point increase in visual field and quality of corrected vision (RR = 1.06; 95% CI = 1.03–1.10), day vision (RR = 1.05; 95% CI = 1.03–1.08), night vision (RR = 1.08; 95% CI = 1.05–1.13), visual acuity score and higher quality of corrected of vision (RR = .41; 95% CI = .22-.77), day vision (RR = .39; 95% CI=.22–.71), and night vision (RR = .41; 95% CI = .18–.94); visual acuity score and ability to drive safely compared to other drivers your age (RR = .53; 95% CI = .29–.96). Individuals with poorer visual acuity and visual fields rate their vision and ability to drive lower than those with better vision, and this information will allow clinicians to understand where to target interventions to enhance safe driving practices.

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Influence of Carteolol and Timolol on IOP and Visual Fields in Glaucoma: A Multi-Center, Double-Masked, Prospective Study

European Journal of Ophthalmology ◽

10.1177/112067219200200402 ◽

1992 ◽

Vol 2 (4) ◽

pp. 169-174 ◽

Cited By ~ 6

Author(s):

J. Flammer ◽

Y. Kitazawa ◽

L. Bonomi ◽

B. Mills ◽

M. Fsadni ◽

...

Keyword(s):

Visual Field ◽

Prospective Study ◽

Beta Blockers ◽

Visual Fields ◽

Visual Field Defects ◽

Eye Drops ◽

Treatment Groups ◽

Visual Field Damage ◽

One Year ◽

Field Defects

The influences of Carteolol and Timolol eye drops on intraocular pressure (IOP) and visual fields were compared in a multi-center, double-masked, prospective study. Two-hundred and forty eyes of 120 patients were initially included in the study, and 142 eyes of 72 patients fulfilled all the criteria for final statistical analysis. Both drugs significantly reduced IOP. The visual fields in both treatment groups did not change during one year of treatment. In both groups some patients improved slightly, and others deteriorated slightly. This indicates that locally applied beta-blockers may efficiently stop further progression of visual field defects in cases with increased IOP and early visual field damage. There was no difference between Carteolol and Timolol in this regard. The side effects were minimal, and there were no differences in their frequency or intensity in the two treatment groups.

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Neuro-ophthalmology: Disorders of Visual Perception, Pupils, and Eyelids

10.1093/med/9780197512166.003.0093 ◽

2021 ◽

pp. 821-833

Author(s):

Shivram Kumar ◽

Kelly D. Flemming

Keyword(s):

Visual Acuity ◽

Visual Field ◽

Visual Perception ◽

Visual Loss ◽

Visual Field Defects ◽

Clinical Disorders ◽

Physical Findings ◽

Abnormal Visual ◽

Visual Changes ◽

Field Defects

Visual loss may develop acutely, subacutely, or insidiously. The course may be transient, static, or progressive. This chapter reviews the causes, diagnosis, and treatment of various disorders resulting in visual loss or abnormal visual perception. In addition, it reviews clinical disorders of the eyelids and pupils. Disorders of visual perception involve visual acuity, color perception, visual field defects, and other visual changes. Historical information and physical findings on examination can help to localize the problem and define the cause.

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Optical Coherent Tomography Predicts Long-Term Visual Outcome of Pituitary Adenoma Surgery: New Perspectives From a 5-Year Follow-up Study

Neurosurgery ◽

10.1093/neuros/nyaa318 ◽

2020 ◽

Vol 88 (1) ◽

pp. 106-112 ◽

Cited By ~ 1

Author(s):

Young Soo Chung ◽

Minkyun Na ◽

Jihwan Yoo ◽

Woohyun Kim ◽

In-Ho Jung ◽

...

Keyword(s):

Pituitary Adenoma ◽

Visual Field ◽

Assessment Tool ◽

Visual Fields ◽

Visual Field Defects ◽

Mean Deviation ◽

Rnfl Thickness ◽

Long Term Follow Up

Abstract BACKGROUND Compressive optic neuropathy is the most common indication for transsphenoidal surgery for pituitary adenomas. Optical coherence tomography (OCT) is a useful visual assessment tool for predicting postoperative visual field recovery. OBJECTIVE To analyze visual parameters and their association based on long-term follow-up. METHODS Only pituitary adenoma patients with abnormal visual field defects were selected. A total of 188 eyes from 113 patients assessed by visual field index (VFI) and 262 eyes from 155 patients assessed by mean deviation (MD) were enrolled in this study. Postoperative VFI, MD, and retinal nerve fiber layer (RNFL) thickness were evaluated and followed up. After classifying the patients into normal (>5%) and thin (<5%) RNFL groups, we investigated whether preoperative RNFL could predict visual field outcomes. We also observed how RNFL changes after surgery on a long-term basis. RESULTS Both preoperative VFI and MD had a linear proportional relationship with preoperative RNFL thickness. Sustained improvement of the visual field was observed after surgery in both groups, and the degree of improvement over time in each group was similar. RNFL thickness continued to decrease until 36 mo after surgery (80.2 ± 13.3 μm to 66.6 ± 11.9 μm) while visual field continued to improve (VFI, 61.8 ± 24.5 to 84.3 ± 15.4; MD, −12.9 ± 7.3 dB to −6.3 ± 5.9 dB). CONCLUSION Patients with thin preoperative RNFL may experience visual recovery similar to those with normal preoperative RNFL; however, the probability of normalized visual fields was not comparable. RNFL thickness showed a strong correlation with preoperative visual field defect. Long-term follow-up observation revealed a discrepancy between anatomic and functional recovery.

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