Absence Of Visual Field Defects Research Articles

The Radiologic Characteristics and Retinal Thickness Are Correlated With Visual Field Defect in Patients With a Pituitary Mass.

Investigation of visual field defects (VFDs) is important to decide the treatment and to predict the prognosis in patients with a pituitary mass. The aim of this study was to evaluate the correlation among 2 diagnostic modalities-MRI and optical coherence tomography (OCT)-and VFDs. Consecutive patients who showed the presence of a pituitary mass on MRI and in whom ophthalmic examinations were performed were recruited. Height and volume of the mass, sagittal and coronal displacement of optic chiasm, and the direction of mass expansion were measured. Patients were divided into 2 groups according to the presence (VFD group) or absence of VFDs (no VFDs group [NVFD]). The correlation among MRI parameters, OCT parameters, and VFDs were examined, and the diagnostic values of MRI and OCT and the combined value of the 2 modalities were analyzed. Forty-one patients were included. The greatest coefficients of determination were observed between the sagittal displacement and pattern standard deviation (PSD) (R2 = 0.3661, P < 0.001) and between the inferonasal ganglion cell-inner plexiform layer (GCIPL) and PSD (R2 = 0.4079, P < 0.001). The height and the size of the mass in the VFD group were significantly greater as 57% and 148%, respectively, and the VFD group had more severe chiasmal displacement both in the sagittal (165%) and in the coronal (178%) plane (large effect in all). All macular GCIPLs were thinner in the NVFD group (range 9%-26%, large effect), whereas only temporal (25%) and average (11%) values were among peripapillary retinal nerve fiber layers. The highest correlations with the degree of the VFD were seen in the sagittal displacement of optic chiasm and the inferonasal GCIPL, and these parameters were correlated concurrently. Both modalities showed a good diagnostic value for discriminating VFDs.

Non-functioning pituitary macroadenoma: surgical outcomes, tumor regrowth, and alterations in pituitary function-3-year experience from the Iranian Pituitary Tumor Registry.

The aim of this study was to assess clinical features and therapeutic outcomes in patients with clinically non-functioning pituitary macroadenomas (NFPMAs). This is a retrospective cohort study of NFPMA patients treated surgically and followed periodically between 2015 and 2017 in a tertiary care center in Iran. Descriptive analysis was performed applying appropriate tests. Binary logistic regression models were used to determine the predictive factors for subtotal tumor resection (STR) and hormonal recovery. Data were analyzed by Stata software. A total of 71 patients with a mean age of 50.6 ± 1.4years were studied. The mean diameter of the adenoma was 26.8 ± 1.1mm. The most frequent symptoms were headache (85.75%), visual field defect (VFD) (78.3%), and hypogonadal symptoms (40.3%). Gross total resection (GTR) was achieved in 45.1%. Preoperative hypopituitarism was observed in 50.7% of patients. Recovery of at least one axis occurred in 36.1% of the patients suffering from hypopituitarism preoperatively, while new-onset postoperative hormonal deficiency appeared in 14.3% of patients. Multivariate analyses showing preoperative tumor size (OR = 38.2; P = 0.008) and cavernous sinus extension (OR = 13.4; P = 0.020) were predictors of STR. Moreover, hormonal recovery was observed not to be related to age, gender, tumor size, or the extent of tumor resection. Tumor size and cavernous sinus extension are the main predictors for STR. Notably, recovery of the gonadal axis in a large proportion of patients supports the surgical resection of NFPAM in patients suffering from gonadal deficiency, even in the absence of VFD.

The time relationship of retinal light threshold fluctuations and retinal nerve fiber layer and ganglion cell complex thickness changes on high-risk primary open-angle glaucoma

Objective To investigate the time relationship of the change, and diagnostic accuracy and sensitivity between retinal light threshold fluctuations (LTF) and retinal nerve fiber layer (RNFL) and ganglion cell complex(GCC) thickness on high-risk primary open-angle glaucoma (POAG). Methods Totally 319 patients (319 eyes) with high-risk in POAG from the First Affiliated Hospital of Kunming Medical Universityand during December 2009 and December 2017, 50 healthy individuals (50 eyes) as control were collected in this longitudinal cohort study. Visual field and OCT were reviewed every 6 months on the high-risk group and every 12 months on the control group. High-risk groups inclusion criteria: vertical C/D≥0.6; early visual field defect (according to glaucoma visual field damage GSS2 quantitative grading standards, mean deviation and pattern standard deviation of central field exceeds the border as an early visual field defect); continuous repeatable results. The first field and OCT results in the absence of visual field defects and C/D≥0.6, which were conformed reliability indicators and removed learning effects as a baseline. When patients achieve POAG diagnosis criteria first time which was recorded as a turning point. And they were divided into early group meanwhile were ended of follow-up. After the last follow-up, the inspection data was segmented counted in yearly interval. The changes of LTF, thickness of RNFL and GCC during the follow-up period in the early POAG group and the control group were observed. The loss rate and change rate in each period were compared for the assessment of their trends with time. Followed by calculation of the area under receiver operating curves (AUC) to compare the predicted value of POAG and the sensitivity at 95% specificity in each period. Results After last follow-up, totally 67 patients 67 eyes (early POAG group, 37 males and 30 females) were entered the turning point. The mean follow-up of the early POAG group and the control group were 6.6 and 6.4 years. The average RNFL thickness was 79.05±8.09 μm, GCC thickness was 71.58±8.41 μm, LTF was −6.05±7.02 dB in early POAG group. The average RNFL thickness was 93.49±6.24 μm, GCC thickness was 79.72±6.32 μm, LTF was −0.31±0.58 dB in the control group. The differences of LTF and the thickness of RNFL and GCC were statistically significant (t=−5.97, −10.42, −5.60; P<0.001). The AUC of RNFL, GCC thickness and LTF increased with time in the early POAG group. The sensitivity was gradually increased at 95% specificity: 5th year before to at turning point, RNFL thickness AUC was 0.15, 0.65, 0.71, 0.77, 0.85, 0.92, and sensitivity was 20%, 56%, 61%, 65%, 70%, 76%, respectively; GCC thickness AUC was 0.12, 0.53, 0.69, 0.74, 0.82, 0.90, and sensitivity was 14%, 53%, 69%, 74%, 82%, 90%, respectively; the AUC of LTF was 0.10, 0.21, 0.33, 0.75, 0.86, 0.91, and sensitivity was 7%, 17%, 44%, 65%, 78%, 87%, respectively. Conclusions The earliest time of structural functional damage of POAG is at the 4th year before confirmed, simultaneous RNFL diagnosis accuracy and sensitivity are better than GCC and LTF. The earliest time of visual functional damage of POAG is at the 2th year before confirmed, simultaneous LTF diagnosis accuracy and sensitivity are better than RNFL and GCC. Key words: Glaucoma, open-angle/diagnosis; Retinal light threshold fluctuation; Retinal nerve fiber layer thickness; Retinal ganglion cell complex thickness; Time relationship

Determining factors of better leptomeningeal collaterals: a study of 857 consecutive acute ischemic stroke patients.

In acute ischemic stroke (AIS) collaterals correlate with infarct size, recanalization rate and clinical outcome. We aimed to identify factors associated with better collateral status in a large series of AIS patients with middle cerebral artery (MCA) occlusion. In the Acute STroke Registry and Analysis of Lausanne (ASTRAL) from 2003 to 2016, we identified all consecutive AIS with proximal MCA occlusion on CT-angiography performed < 24h. Collaterals were scored from 0 (absent) to 3 (≥ 100%) and related to multiple demographic, clinical, metabolic and radiological variables in a multivariate regression analysis (MVA). The 857 included patients had a median age of 72.3years, 48.4% were female and median admission NIHSS was 16. Better collaterals were associated with younger age (OR 0.99; 95% CI 0.98-1.00), hemineglect (OR 1.35; 95% CI 1.03-1.76), absence of visual field defects (OR 0.64; 95% CI 0.46-0.90), eye deviation (OR 0.58; 95% CI 0.43-0.79) and decreased vigilance (OR 0.62; 95% CI 0.44-0.88). Better collaterals were also associated with dyslipidemia (OR 1.57; 95% CI 1.16-2.13), no previous statin use (OR 0.69; 95% CI 0.50-0.95), and lower creatinine levels (OR 0.99; 95% CI 0.99-1.00). On neuroimaging, better collaterals related to higher ASPECTS score (OR 1.27; 95% CI 1.20-1.35) and higher clot burden score (OR 1.09; 95% CI 1.03-1.14). Younger age, dyslipidemia and lower creatinine levels were predictors of better collaterals in AIS patients from proximal MCA occlusions. Greater degree of collaterals related to lower stroke severity on admission. On neuroimaging, better collaterals were independently associated with minor early ischemic changes and lower clot burden. These data may add knowledge on pathophysiology of collaterals development and may help to identify patients with better collaterals for late or aggressive recanalization treatments.

Cocaine-Induced Pituitary Apoplexy and Panhypopituitarism

ABSTRACT Objective: Chronic cocaine use has been implicated in panhypopituitarism. Acute cocaine intoxication resulting in pituitary apoplexy and panhypopituitarism has not been reported in the literature. Methods: We hereby report a case of panhypopituitarism resulting from pituitary apoplexy induced by a single intranasal cocaine use. Results: A 54-year-old African American man presented with a week-long headache that started 2 hours after snorting a gram of cocaine. His physical exam was normal. His labs were suggestive of panhypopituitarism. Anti-neutrophil cytoplasmic antibodies were negative. Brain magnetic resonance imaging with and without contrast showed a large complex sellar mass with hemorrhagic and necrotic components. Surgical decompression was deferred due to normal visual acuity and absence of visual field defects. He received a stress dose of glucocorticoids followed by maintenance dose and was discharged on the glucocorticoid with levothyroxine replacement. The patient has been lost to f...

Relationship between the retinal nerve fibre layer (RNFL) parameters and visual field loss in established glaucoma patients in South Indian population

Purpose: Optical coherence tomography (OCT) and Scanning LASER polarimetry (GDX-VCC) are newer techniques to analyse retinal nerve fibre loss in glaucoma. This study aims to evaluate the relationship between the Retinal Nerve Fibre Layer(RNFL) parameters measured using Stratus-OCT and GDx-VCC and visual field loss by Octopus interzeag perimetry in established glaucoma patients in South Indian Population. Materials and methods: Prospectively planned cross sectional study of 67 eyes of 34 established glaucoma patients on medical management. The mean age of patients was 46.911 years (SD+13.531). A complete ophthalmic examination, automated perimetry with octopus interzeag 1-2-3 perimeter, retinal nerve fibre analysis with GDx VCC and Stratus OCT was done. The differences between the mean RNFL parameters in the presence or absence of field defects were evaluated. Results: The data analysed were mean deviation, loss variance, OCT total average nerve fibre thickness, GDX VCC- TSNIT average and Nerve fibre indicator (NFI).The data were split into two subgroups on the basis of presence or absence of visual field defect and analysed. The difference between the mean value of NFI between the subgroups was highly significant with a p value < 0.01.The OCT parameter Total average nerve fiber layer thickness differed significantly between the two subgroups (p value <0.05). The mean GDx TSNIT average did not differ significantly between the two subgroups. Conclusion: The total average nerve fibre thickness by OCT correlated better with visual field loss than the GDX TSNIT average .Among the GDx parameters, the NFI was found to be a better indicator of visual field damage than the average thickness.

Outcomes of Gamma Knife surgery for craniopharyngiomas

Gamma Knife surgery (GKS) has emerged as a valuable adjuvant treatment modality for recurrent or residual craniopharyngioma. However, prognostic factors pertaining to progression-free survival (PFS) remain poorly understood. A study was conducted to address this issue. A total of 37 consecutive patients undergoing 39 sessions of GKS procedures targeting the solid portions of the tumors at our institution between 1989 and 2005 were analyzed. Twenty-one male and 16 female patients comprised this study. Median age at GKS was 36 years (range, 4-78). Median tumor volume was 1.6 cm(3) (range, 0.1-18.6), median marginal dose was 14.5 Gy (range, 6-25), and median maximal dose was 30 Gy (range, 15.6-60). Median follow-up was 50 months (range, 8-212). Univariate and multivariate analyses using Cox proportional hazards model were employed to identify the potential prognostic factors including tumor volume, marginal dose, gender, age at GKS, and status of visual field defect (VFD) in terms of in-field PFS. The actuarial 3- and 5-year in-field PFS were 84.8 and 67.0%, respectively. On univariate analysis, absence of VFD at GKS was a favorable prognostic factor (hazard ratio: 0.279; 95% CI, 0.085-0.913, P = 0.035), whereas on multivariate analysis, absence of VFD at GKS, tumor volume ≤1.6 cm(3), and marginal dose >14.5 Gy related to a longer in-field PFS. GKS may offer reasonable control of recurrent or residual craniopharyngiomas. There was a consistent correlation between absence of VFD at the time of GKS and in-field PFS.

Palinopsia From Posterior Visual Pathway Lesions Without Visual Field Defects

Palinopsia, or perseveration of a previously viewed image, may be caused by drug use or by posterior visual pathway lesions. Most cases of palinopsia due to visual pathway lesions have an associated homonymous hemianopic visual field defect. We report two patients with palinopsia caused by structural lesions of the posterior visual pathway in the absence of visual field defects. Patients with palinopsia should undergo neuroimaging even in the presence of normal visual fields.

Histologically Proven Lymphocytic Hypophysitis: Spontaneous Resolution and Subsequent Pregnancy

Of the 128 previously reported cases of lymphocytic hypophysitis, the diagnosis was histologically proven in 6 patients in whom the pituitary mass regressed spontaneously; only 1 subsequently became pregnant. Among six additional patients who became pregnant after a diagnosis of presumed lymphocytic hypophysitis, the disease was confirmed histologically in only three, two of whom underwent surgical debulking and one who had no follow-up imaging. To our knowledge, we describe the second patient with histologically proven lymphocytic hypophysitis, associated with adrenocorticotropic hormone (corticotropin) and prolactin deficiencies, in whom the pituitary mass regressed completely with physiologic hydrocortisone therapy only and in whom a spontaneous pregnancy occurred subsequently with no postpartum recurrence of the pituitary mass. This information lends credence to previous recommendations that, in the absence of visual field defects, surgical and corticosteroid therapy may be safely withheld, with periodic reassessment.

Current controversies in the white dot syndromes Multifocal choroiditis, punctate inner choroidopathy, and the diffuse subretinal fibrosis syndrome

The white dot syndromes are inflammatory diseases of unknown etiology which share several clinical features. The presence or absence of visual field defects, abnormal electroretinograms, lesions on indocyanine green angiography, and specific antiretinal antibodies may give us clues to their pathogenesis. Careful prospective studies into these features may enable us to differentiate between these diseases and facilitate further research toward developing effective treatments.

Visual evoked potential abnormalities in compressive chiasmal lesions: the relevance of central visual field defects

In healthy subjects, the pattern visual evoked potential (VEP) arises predominantly from the stimulation of the central 5 degrees of the visual field. This central-field paradigm is well confirmed in VEP studies of retrochiasmal lesions, but it appears to be more ambiguous in patients with compressive lesions of the chiasm. To further clarify how central and peripheral visual field defects affect VEP, we compared the Goldmann perimetric charts with the frequency and type of VEP abnormalities in 25 patients in whom a compressive chiasmal lesion had been confirmed by CT. Perimetric findings were compared with the full-field and half-field VEP records with regard to the presence or absence of defects within the 0-5 degrees of the visual field. Full-field VEP abnormalities were present in all eyes with absolute, in 81% of the eyes with relative central visual field defects, and in 59% of the eyes with no impairment of the central visual field. Half-field VEP abnormalities were found in all half-fields with absolute, in 89% of half-fields with relative central visual field defect, and in 77% of half-fields that manifested visual field defects without macular involvement. We also found abnormalities in 36% of half-field VEP recordings, obtained by stimulation of apparently normal visual half-fields. The analysis of the types of VEP abnormalities showed that Pi00 amplitude attenuation typically reflected the central field defect, while Pi00 asymmetry, Pi00 prolongation, and Pi35 appearance could be detected in both the presence or absence of the central field impairment. Our results confirm that central visual field defects are associated with VEP abnormalities. However, the high proportion of VEP abnormalities in eyes with field defects not affecting the central 5 degrees, and the VEP half-field abnormalities even in an absence of visual field defect indicate that compressive chiasmal lesions may be reflected in abnormal VEP well before the appearance of central-field defects in the Goldmann perimetric tests.

Visual Field Defects in Relation to Head Injury Severity

A total of 159 head-injured patients were classified into four groups based on two acute categories of injury severity (minor-to-moderate and severe) and the subsequent presence or absence of visual field defects (VFDs). They were assessed neuropsychologically within ten to 19 months after injury. Within both minor-to-moderate and severe injury classifications, patients with VFDs were more impaired neuropsychologically and had more frequent acute secondary intracranial complications (brain swelling, intracranial hypertension, and cerebral hyperemia) than patients without VFDs. The findings suggest that the presence of VFDs during the long-term period may be residuals of acute secondary complications indicative of increased neuropsychological deficits after head injury.

Biometric study of the disc cup in open-angle glaucoma.

Stereoscopic and photogrammetric study of the disc cup in open-angle glaucoma reveals several morphological changes. The ovalisation of the cup, upwards, downwards or on the temporal side, appears early. It can be detected at the onset of the disease, even in the absence of visual field defects. It results in a localised thinning of the nervous rim, which is a characteristic sign of beginning glaucoma, but the depth of the cup is not increased even when perimetry already reveals important defects. The aim of this paper is to study, on the one hand, the morphological changes of the disc cup and on the other, the functional defects in open-angle glaucoma, and then to compare the results of the investigations.

Adaptive programs for analysis of the visual field by automatic perimetry--basic problems and solutions. Efforts oriented towards the realisation of the generalised spatially adaptive Octopus program SAPRO.

Adaptive programs have been developed, which adjust the spatial resolution of automatic perimeter measurement according to the presence or absence of visual field defects. Information obtained during the examination is fed back to an adaptively interacting algorithm controlling further examination steps. Using this strategy, defective areas are examined in detail but less time is wasted on regions of normal contrast sensivity.

The Hemispheric Side of Neocortical Damage Does not Affect Memory for Unidimensional Position. An Experiment with Posner and Konick's Test

The role of neocortical areas in visuo-spatial memory was investigated by testing unilateral hemisphere-damaged patients for their ability to reproduce the position of a dot on a horizontal line after a delay. One hundred and eleven patients, divided into 4 groups on the basis of the side of damage and of the presence or absence of visual field defects, and 56 controls were tested.There were 2 sets of experimental conditions: (i) a free delay condition of 0, 20 or 180 sec., and (ii) a 20 sec. delay condition filled with 2 kinds of interpolated perceptual activity.Forgetting was significantly affected by presence of hemisphere damage, but not by the side and the intrahemispheric locus of lesion. It was concluded that the memory ability involved by this task is not related to the functioning of a specific cortical area.

The mode of progressive disc cupping in ocular hypertension and glaucoma.

Serial disc photographs of 259 patients with elevated intraocular pressures were studied retrospectively up to 15 years. Twenty-nine eyes showed progressive enlargement of the optic cup. Early vertical extension of the cup occurred in vertical extension of the cup occurred in five eyes and horizontal extension in one. In 23 eyes, a generalized expansion of the cup (retaining its round appearance) was the first change observed, typically preceding visual field loss by several years. Thus, serial disc photographs are necessary for the earliest detection of optic nerve damage in ocular hypertension. Of 18 eyes with normal visual fields at the time progression of cupping was first noted, typical glaucomatous field loss developed in 50% during a follow-up of one to six years (average, two years). Therefore, treatment is indicated for eyes exhibiting progressive disc cupping, even in the absence of visual field defects.

Impairment of Color Sorting Behavior After Hemispheric Damage: An Experimental Study with the Holmgren Skein Test

This study aimed at assessing whether the Holmgren skein sorting test, a test repeatedly used in cases of impaired color behavior, predominantly involves hue discrimination, as claimed by some authors, or abstract thinking, as maintained by Gelb and Goldstein. Eighty control patients and 165 brain-damaged patients were examined. The brain-damaged sample was classified according to the hemispheric side of the lesion and to presence or absence of visual field defect (VFD). Left hemisphere patients were also subdivided as to presence or absence of aphasia. Three brain-damaged groups were found impaired with respect to controls: right hemisphere patients with VFD and the two aphasic groups, with and without VFD. To evaluate the relationship between Holmgren performance and proficiency in hue discrimination and in abstract thinking, the scores obtained by patients on the Farnsworth test and on the Weigl test were introduced as covariates in the analysis of the Holmgren means. By computing the regression coefficients, it was found that the Farnsworth scores significantly adjusted the Holmgren scores, while the Weigl scores did not. The Holmgren scores were not significantly correlated in aphasics with the scores of an oral comprehension test, the Token test. It is concluded that right hemisphere patients with VFD fail on the Holmgren test, because they are impaired in hue discrimination. The reason for aphasics’ poor performance is, on the other hand, not clear. Results are inconsistent with the hypothesis that their failure reflects a disorder of language or of conceptual thinking.

Polytome-encephalography in the investigation of pituitary tumours

Thirty-seven patients suffering from various types of pituitary tumours have been examined by pneumoencephalography combined with tomography using the Philips polytome. The technique described uses careful premedication by phenoperidine and haloperidol. Circular tomography in sagittal and coronal planes showed suprasellar anatomy in 39 out of 40 examinations. Fourteen patients had suprasellar extensions of tumour and three patients showed intrasellar air. The importance of accurate anatomical assessment of pituitary tumours is discussed. Suprasellar extension could not be predicted from the shape of the sella. Suprasellar extension may exist in the absence of visual field defects.

Impairment of Memory for Position Following Brain Damage

Memory for position was investigated in control (N = 30) and brain-damaged patients (N = 121) by a visually and a tactually guided test, that required the S s to locate by memory items in two rows. The braindamaged group was subdivided according to hemispheric side of lesion and to presence or absence of visual field defects. The performance of the controls was better than that of patients with cerebral injury on both tests. There was no significant difference between right and left hemisphere damaged patients, while patients with field defects performed lower than patients without field defects. However, the finding that this impairment was significantly more marked on the tactile than on the visual memory test suggests that it is related to the concomitant injury of posterior areas of the brain rather than to the effect of the visual deficit. The correlations between memory scores and scores obtained on a language test and on spatial perceptual tests were investigated separately in the two hemispheric groups. There was a trend for a higher association with spatial perceptual scores in the right brain-damaged group and with language scores in the left brain-damaged group.