Visual field defects in 169 cases of pituitary adenomas

Abstract

To compare static visual field perimetry with Octopus 101 and Goldmann perimetry in patients with pituitary adenomas; To identify the factors of visual field defects and visual field prognosis. Retrospective nested case-control study. Visual acuity, fundus, computed tomography (CT) or magnetic resonance imaging (MRI) and visual field were pre-operated assessed in 169 patients (338 eyes) diagnosed pituitary adenoma at the Department of Neurosurgery in Huashan Hospital between Feb. 2006 and Feb. 2007. 334 eyes were underwent Goldmann perimetry, while 323 eyes were underwent static visual field perimetry with Octopus 101 perimeter. In the 169 patients, 28 patients (56 eyes) were followed up post-operatively for 3 to 6 months. Statistical analysis was performed using SPSS 15.0 software. T test and rank sum test were used for continuous variables, and chi-square test and Fisher's exact test were used for categorical variables. We also carry out Logistic regression. Of the 169 patients, unilateral or bilateral visual field defects were observed in 133 cases. In these 323 eyes, 231 eyes showed visual field defects with static visual field perimetry, while 196 eyes in 334 eyes showed defects with Goldmann perimetry. Earlier age of onset, larger tumors and poor preoperative corrected visual acuity were more frequent in patients with visual field defects than in patients with normal visual fields (t = 4.802, 7.930; chi(2) = 28.210, P < 0.01). In the 28 followed-up patients (55 eyes), visual acuity was improved in 69.05% eyes and visual field was improved in 85.71% eyes after operation. There were significant differences in age of onset and preoperative visual field defects in upper temporal quadrants between patients with visual field returned to normal after the operation and patients with visual field improvement only (t = 2.525, P = 0.023; chi(2) = 6.218, P = 0.013). Static visual field perimetry with Octopus 101 perimeter is more sensitive than Goldmann perimetry in the early diagnosis of pituitary adenomas. Patients with visual field abnormalities are significantly with earlier onset age, larger tumors and worse preoperative visual acuity than patients free of visual field defects. The onset age and the degree of impairment in the preoperative visual field in the upper temporal quadrant may be significant factors for visual field prognosis.