Abstract
PurposeThe aim of the present study is to analyze the changes in retinal vessel density (VD), using Optical Coherence Tomography Angiography (OCT-A), in patients that received endoscopic endonasal approach for the removal of an intra-suprasellar pituitary adenoma compressing optic chiasm.MethodsWe evaluated the VD in Superficial Capillary Plexus (SCP), Deep Capillary Plexus (DCP), Radial Peripapillary Capillary (RPC) and the Foveal Avascular Zone (FAZ) area in a series of fourteen patients (7 males, 7 females, mean age 56 ± 13 years), as compared to healthy controls. We also detected the structural Spectral Domain (SD)-OCT parameters: Ganglion Cell Complex (GCC), Retinal Nerve Fiber Layer (RNFL), visual field parameters (Mean Deviation, Pattern Standard Deviation) and Best Corrected Visual Acuity (BCVA). These measurements were performed prior than surgery and 48 hours after.ResultsThe patients showed a significant decrease in VD of the macular and papillary regions, a significant increase in FAZ area, a significant impairment in SD-OCT, VF parameters and BCVA respect to 14 eyes of 14 healthy controls (p<0.05), at pre-op evaluation. In patients group the VD in SCP, DCP and RPC increased after surgery respect to baseline but the difference turned to be out statistically significant only in RPC (p = 0.003). Also the BCVA (p = 0.040) and the Mean Deviation at visual field (p = 0.015) significantly improved after surgery. While there was a reduction in structural OCT parameters but it was statistically significant only in GCC (p = 0.039). A positive correlation was found between the preoperative VD of the RPC, Mean Deviation, BCVA and the postoperative Mean Deviation (r = 0.426 p = 0.027; r = 0.624 p = 0.001; r = 0.515 p = 0.006).ConclusionOCT-A allows to detect the early changes occurring within 48 hours after surgery showing that the improvement in retinal vessel density could occur before the recovery of the structural OCT parameters and can be a positive predictive factor for the functional recovery.
Highlights
Visual impairment due to optic chiasm or optic nerve compression is most commonly detected in patients harboring intra-suprasellar lesions, e.g. pituitary adenomas, Rathke cleft cysts, craniopharyngiomas, accounting for up to 10–15% of all intracranial tumors [1]
The patients showed a significant decrease in vessel density (VD) of the macular and papillary regions, a significant increase in Foveal Avascular Zone (FAZ) area, a significant impairment in Spectral Domain (SD)-Optical Coherence Tomography (OCT), visual field (VF) parameters and Best Corrected Visual Acuity (BCVA) respect to 14 eyes of 14 healthy controls (p
In patients group the VD in Superficial Capillary Plexus (SCP), Deep Capillary Plexus (DCP) and Radial Peripapillary Capillary (RPC) increased after surgery respect to baseline but the difference turned to be out statistically significant only in RPC (p = 0.003)
Summary
Visual impairment due to optic chiasm or optic nerve compression is most commonly detected in patients harboring intra-suprasellar lesions, e.g. pituitary adenomas, Rathke cleft cysts, craniopharyngiomas, accounting for up to 10–15% of all intracranial tumors [1]. Since the introduction of Optical Coherence Tomography (OCT), an imaging technique that utilizes near-infrared light interferometry to generate in vivo cross-sectional and three-dimensional volumes of retinal layers, it has been possible to reveal permanent structural anatomical changes, more precisely define the likelihood of functional recovery [6]. Several optical coherence tomography angiography (OCT-A) methods have been developed especially for the reconstruction of three-dimensional noninvasive chorioretinal vascular imaging and are gaining popularity for the diagnosis of optic neuropathies [7,8,9,10,11,12,13]
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