https://doi.org/10.31288/oftalmolzh201836873

Value of static automated perimetry in assessing visual impairments in patients with pituitary adenoma with suprasellar extension

K.S. Iegorova, Cand Sc (Med), M.O. Guk, Dr Sc (Med), L.V. Zadoianyi, Cand Sc (Med), O.M. Guk, Cand Sc (Med)

Romodanov Neurosurgery Institute; Kyiv (Ukraine)

E-mail: iegorova_katya@ukr.net                     

TO CITE THIS ARTICLE: Iegorova KS, Guk MO, Zadoianyi LV, Guk OM. Value of static automated perimetry in assessing visual impairments in patients with pituitary adenoma with suprasellar extension.  J.ophthalmol.(Ukraine).2018;3:68-73. https://doi.org/10.31288/oftalmolzh201836873

       

Background: Pituitary adenoma (PA) is a neoplasm that develops from anterior pituitary cells and accounts for 20-25% of all intracranial extracerebral tumors. In a functioning PA, a specific clinical syndrome develops, and, therefore, the diagnosis can be made early, when the tumor is small. In a non-functioning PA, the early stage is often asymptomatic and the disease is usually diagnosed only with the onset of visual impairment, with 3.5% to 16% of patients having blindness as an outcome.

Purpose: To investigate changes in the visual field in pituitary adenomas with suprasellar extension and various anatomical positions of the optic chiasm.

Materials and Methods: Ninety-six (100%) patients with a non-invasive PA with suprasellar extension were under surveillance at the Romodanov Neurosurgery Institute between 2015 and 2016, and underwent clinical neurological and ophthalmological examination and comprehensive neuroimaging evaluation. Inclusion criteria were a history of surgical procedure for a non-invasive PA with suprasellar extension, and visual impairment.

Results and Discussion: Of the 96 patients, 50 (52%) had visual impairment, and were included in the analysis. Bitemporal visual field changes and homonymous hemianopia were found in 48 (96%) patients and 2 (4%) patients, respectively. Symmetric, asymmetric or markedly asymmetric chiasmal syndrome was found in 32 (67%), 11 (23%), and 5 (10%) patients, respectively. Of the 50 patients, 8 (16%) had a prefixed chiasm, and 3 (6%; patients with a bitemporal constriction of the visual fields) had a postfixed chiasm. Patients with pituitary adenoma may have a delayed onset of or no visual impairment due to the presence of a prefixed or postfixed chiasm.

Conclusion: Static automated perimetry (SAP) is a sensitive and objective technique for detecting visual field defects in patients with PA with suprasellar extension. The SAP demonstrated characteristic visual field changes in temporal halves, with a degree of visual field loss ranging from mean deviation −1.26 to −19.31 dB.

Keywords: pituitary adenoma, positions of the chiasm, automated static perimetry

References

1.Abouaf L, Vighetto A, Lebas M. Neuro-ophthalmologic exploration in non-functioning pituitary adenoma. Ann Endocrinol (Paris). 2015 Jul;76(3):210-9
Crossref   Pubmed

2.Rivoal O, Brézin AP, Feldman-Billard S, Luton JP. Goldmann perimetry in acromegaly: a survey of 307 cases from 1951 through 1996. Ophthalmology. 2000 May;107(5):991-7.
Crossref   Pubmed

3.Guk MO. [Diagnosis and treatment of non-functioning pituitary adenomas]. [Dr Sc (Med) dissertation]. Kyiv: Romodanov Neurosurgery Institute; 2017. 328 p. Ukrainian

4.Nishimura M, Kurimoto T, Yamagata Y, et al. Giant pituitary adenoma manifesting as homonymous hemianopia. Jpn J Ophthalmol. 2007 Mar-Apr;51(2):151-3.
Crossref   Pubmed

5.Kitthaweesin K, Ployprasith C. Ocular manifestations of suprasellar tumors. J Med Assoc Thai. 2008;91(5):711–5.

6.Halle AA, Drewry RD, Robertson JT. Ocular manifestations of pituitary adenomas. South Med J. 1983 Jun;76(6):732-5
Crossref   Pubmed

7.Lee IH, Miller NR, Zan E, et al. Visual Defects in Patients With Pituitary Adenomas: The Myth of Bitemporal Hemianopsia. AJR Am J Roentgenol. 2015 Nov;205(5):W512-8
Crossref   Pubmed

8.Kan E, Kan EK, Atmaca A, et al. Visual field defects in 23 acromegalic patients. Int Ophthalmol. 2013 Oct;33(5):521-5.
Crossref   Pubmed

9.Ogra S, Nichols AD, Stylli S, et al. Visual acuity and pattern of visual field loss at presentation in pituitary adenoma. J Clin Neurosci. 2014 May;21(5):735-40. 
Crossref   Pubmed

10.Schiefer U, Isbert M, Mikolaschek E, et al. Graefes Arch Clin Exp Ophthalmol. 2004 Jun;242(6):468-77.
Crossref   Pubmed

11.Serova NK. [Clinical neuro-ophthalmology: Neurosurgical aspects]. Tver: Triada LLC; 2011. Russian

12.EZh Tron. [Visual pathway disorders]. Moscow: Medgiz; 1955. Russian