The role of OCT- angiography in predicting anatomical and functional recovery after endoscopic endonasal pituitary surgery: A 1-year longitudinal study.

G Cennamo,M R Scala,D Montorio,L M Cavallo,D Solari,F Tranfa,L D’Andrea,Radouil Tzekov

doi:10.1371/journal.pone.0260029

G Cennamo, M R Scala + Show 6 more

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https://doi.org/10.1371/journal.pone.0260029

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Journal: PloS one	Publication Date: Dec 2, 2021
Citations: 3	License type: CC BY 4.0

Affiliation: University of Naples Federico II

Abstract

PurposeThe purpose of this study was to investigate the changes in structural spectral-domain optical coherence tomography (SD-OCT), OCT Angiography (OCTA) parameters, and visual acuity, 1 year after endoscopic endonasal approach for the removal of an intra-suprasellar pituitary adenoma compressing optic chiasm and compare outcomes with 48 hours postoperative data.MethodsSixteen eyes of eight patients (4 males, 4 females, mean age 52 ± 11 years) were enrolled in this prospective study. The primary outcome was to evaluate the changes over time before and after surgery, analyzing the Best Corrected Visual Acuity (BCVA), Ganglion Cell Complex (GCC), Retinal Nerve Fiber Layer (RNFL) thicknesses, the retinal vessel density (VD) of Superficial Capillary Plexus (SCP), Deep Capillary Plexus (DCP), Radial Peripapillary Capillary (RPC) and the Foveal Avascular Zone (FAZ). The secondary outcome was to identify potential biomarkers that could predict visual acuity changes after 1-year follow-up.ResultsWhen comparing SD-OCT and OCTA measurements obtained after 1 year with those observed 48 hours after surgery, GCC and RNFL were significantly improved. After a significant reduction at 48 hours, GCC thickness showed a significant increase at 1 year after surgery (p = 0.007), while a significant restoration of RNFL thickness was found at 1 year (p = 0.005), as well as the VD of SCP, DCP, and RPC values. FAZ area did not change over time. BCVA significantly improved at each time after surgery (p = 0.037, p = 0.013). A statistically significant correlation was found between the preoperative BCVA, VD of SCP, DCP, RPC, and the postoperative BCVA at 1 year (p = 0.017, p = 0.029, p = 0.031, p = 0.023).ConclusionSD-OCT and OCTA provide helpful information to identify the retinal structural and vascular improvements 1 year after surgery. OCTA parameters could serve as potential predictive markers for visual acuity recovery at long-term follow-up.

Highlights

Anterior visual pathway compression is a common feature of intra-suprasellar masses and may lead to visual disturbances of various entities [1]
When comparing spectral-domain optical coherence tomography (SD-OCT) and OCT Angiography (OCTA) measurements obtained after 1 year with those observed 48 hours after surgery, Ganglion Cell Complex (GCC) and Retinal Nerve Fiber Layer (RNFL) were significantly improved
After a significant reduction at 48 hours, GCC thickness showed a significant increase at 1 year after surgery (p = 0.007), while a significant restoration of RNFL thickness was found at 1 year (p = 0.005), as well as the vessel density (VD) of Superficial Capillary Plexus (SCP), Deep Capillary Plexus (DCP), and Radial Peripapillary Capillary (RPC) values

Summary

Introduction

Anterior visual pathway compression is a common feature of intra-suprasellar masses and may lead to visual disturbances of various entities [1]. Endoscopic endonasal surgery, allowing an optimal decompression, offers the best results in terms of surgical resection and outcomes for treating these lesions, e.g., pituitary adenomas, Rathke cleft cysts, craniopharyngiomas, accounting for up to 10–15% of all intracranial tumors, respect to other techniques, such as microsurgical one [3,4,5]. The reconstruction of the three-dimensional anatomical and chorioretinal vascular structures for the diagnosis of optic neuropathy has become possible using the noninvasive optical coherence tomography and, in particular, by its angiography protocol [6,7,8,9,10,11,12]. We recently described the predictive role of optical coherence tomography angiography (OCT-A) regarding visual recovery by investigating the early vessel density modifications at 48 hours after endoscopic endonasal pituitary surgery. Considering the data, we had assumed that early modifications in vessel density obtained by OCT-A examination might precede the OCT parameters normalization [13]

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