Association of retinal nerve fibre layer thickness with quantitative magnetic resonance imaging data of the optic chiasm in pituitary adenoma patients

Insights into Visual Outcomes and Determinants in Pituitary Adenoma Surgery: A 5-Year Retrospective Cohort Study

Purpose

To investigate the long-term visual outcome and their determinants after an operation in Thai pituitary adenoma (PA).

Patients and Methods

A retrospective cohort study was conducted on PA patients who underwent surgery at Rajavithi Hospital. Baseline characteristics and visual parameters, including visual acuity (VA) and visual field (VF), were analyzed in relation to the visual prognosis outcome. The outcome was defined as VA improvement at 1-year postoperatively. Visual parameters were measured at each follow-up visit and compared. Factors for improved visual prognosis were evaluated using logistic regression analysis.

Results

A total cohort of 87 patients (64.37% female), 62.07% showed improvement in visual outcome. Most improvement occurred immediately after surgery, evident at the 1-month visit. The mean follow-up time was 47.45 months (±28.49 SD), mean difference in VA improvement at 1-year was -0.56 logMAR (95% CI -0.73, -0.47). In multivariable logistic regression model, prolonged onset duration was associated with a reduced odds of improved visual outcome, with an odds ratio (OR) of 0.946 (95% CI 0.899-0.996, p = 0.034). Baseline characteristics, tumor volume, Hardy and Knops classification, and surgical approaches were not identified as significant predictors.

Conclusion

Both TSS and transcranial approaches are effective for pituitary adenoma. A prompt operation is recommended for patients with prolonged onset duration, with thorough discussion on poor postoperative visual outcomes.

Evaluation of preoperative visual pathway impairment in patients with non-functioning pituitary adenoma using diffusion tensor imaging coupled with optical coherence tomography

Objective

Optic chiasma compression and associated visual impairment induced by a non-functioning pituitary adenoma (NFPA) is commonly assessed by the optic disk and retina but is inadequate to understand the entire visual pathway impairment. We aim to evaluate the use of optical coherence tomography (OCT) coupled with diffusion tensor imaging (DTI) for the preoperative evaluation of visual pathway impairment.

Methods

Fifty-three patients with NFPA (categorized into mild and heavy compression subgroups) were subjected to OCT to calculate the thickness of the circumpapillary retinal nerve fiber layer (CP-RNFL), macular ganglion cell complex (GCC), macular ganglion cell layer (GCL), and macular inner plexus layer (IPL), as well as to DTI to calculate the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values.

Results

Compared to mild compression, heavy compression caused decreased FA value, increased ADC value of several segments of the visual pathway, thin temporal CP-RNFL, and quadrant macular GCC, IPL, and GCL. Average CP-RNFL thickness, inferior-macular inner-ring IPL and GCC thicknesses, inferior CP-RNFL thickness, and superior CP-RNFL thickness were the best indicators of the impairment of the optic nerve, optic chiasma, optic tract, and optic radiation, respectively.

Conclusion

DTI and OCT parameters can effectively evaluate visual pathway impairment and are beneficial for the objective preoperative evaluation of visual pathway impairment in patients with NFPA.

Retinal nerve fiber layer thickness and its correlation with visual symptoms and radiological features in pituitary macroadenoma

Objective

The aim of the study was to evaluate the association of the thickness of retinal nerve fiber layer (RNFL) with (i) visual symptoms and (ii) suprasellar extension defined by magnetic resonance imaging (MRI) in patients with pituitary macroadenoma.

Materials and Methods

RNFL thickness of 50 consecutive patients operated for pituitary macroadenoma between July 2019 and April 2021 were compared with standard visual examination findings and MRI measurements such as optic chiasm height, distance between the optic chiasm and adenoma, suprasellar extension, and chiasmal lift.

Results

The study group included 100 eyes of 50 patients operated for pituitary adenomas with suprasellar extension. RNFL thinning predominantly involved the nasal (84.26 ± 16.43 μm) and temporal quadrants (70.72 ± 14.80 μm) and correlated well with the visual field deficit (P < 0.001). Patients with moderate-to-severe deficit in visual acuity had a mean RNFL thickness <85 μm and patients with severe disc pallor had extremely thin RNFLs (<70 μm). Suprasellar extension defined as Wilsons Grade C, D, and E and Fujimotos Grades 3 and 4 were significantly associated with thin RNFLs <85 μm (P < 0.01). Chiasmal lift more than 1 cm and tumor chiasm distance of <0.5 mm were associated with thin RNFL (P < 0.002).

Conclusion

RNFL thinning correlates directly with the severity of visual deficits in patients with pituitary adenoma. Wilsons Grade D and E, Fujimoto Grade 3 and 4, chiasmal lift more than 1 cm, and chiasm tumor distance <0.5 mm are strong predictors of RNFL thinning and poor vision. Pituitary macro adenoma and other suprasellar tumors need to be excluded in patients with preserved vision but having obvious RNFL thinning.

Sellar masses: diagnosis and treatment

Sellar mases can cause a variety of neuro-ophthalmic manifestations, including compressive optic neuropathy, chiasmal syndrome, and ophthalmoplegia due to cranial nerve palsy. Diagnosis involves a thorough history, neuro-ophthalmic examination, and ancillary tests and investigations. Visual field testing is critical in diagnosing and localizing the lesion and determining the extent of visual field loss. Appropriate neuro-imaging is essential in characterizing and localizing the lesion. Neuro-ophthalmologic assessment include meticulous clinical examination and ancillary tests including,visual field testing, which is useful in localizing the lesion, and optical coherence tomography, which is helpful in assessing the degree of axonal and neuronal loss and predicting the visual outcome. Treatment requires a multidisciplinary approach by different specialties, including radiologists, neuro-ophthalmologists, and neurosurgeons. The two primary treatment modalities for these tumors are surgery and radiation therapy. We review the main types of sellar lesions, their neuro-ophthalmologic evaluation, and treatment options.

Optical coherence tomography angiography characteristics of the retinal and optic disc morphology in prolactinoma

PURPOSE

To investigate changes in the retinal and optic disc (OD) morphology in prolactinoma patients without optical chiasmal compression and/or visual field defects using optical coherence tomography angiography (OCTA).

METHODS

In this cross-sectional imaging study, 16 consecutive prolactinoma patients (group 1, 32 eyes) and 15 age- and gender-matched healthy subjects (group 2, 30 eyes) underwent a thorough neuro-ophthalmological examination, which included testing for the presence of any intracranial compressive lesion that could cause optic neuropathy. Retinal morphological parameters, outer retinal and choriocapillaris flow areas, as well as OD vessel density (VD) and retinal nerve fiber layer (RNFL) thickness in for quadrants were then measured using OCTA.

RESULTS

Mean age (p = 0.537) and gender (p = 0.385) of participants in groups 1 and 2 did not differ significantly. The mean BCVA for both groups was 0.00 ± 0.00 logMAR. Microadenomas made up the majority of prolactinomas (87.1 %). All retinal morphological parameters in deep capillary plexus (excluding foveal VD) differed significantly between groups 1 and 2 (whole: p < 0.001, parafoveal: p = 0.021, and perifoveal: p < 0.001). Peripapillary RNFL thickness in temporal (p < 0.001), nasal (p = 0.010), and inferior (p = 0.007) quadrants also differed significantly between the two groups. Foveal deep (r = -0.304, p = 0.035) and choriocapillaris flow (r = -0.511, p = 0.008) were negatively correlated with tumor size at diagnosis.

CONCLUSIONS

Significant microvascular morphological changes, particularly in the deep retinal layer, as well as in the peripapillary RNFL thickness, were observed in prolactinoma patients. OCTA appears to be capable of detecting non-manifest circumpapillary and even intra-retinal microvascular changes even when there are no obvious signs of prolactinoma-related ocular complications caused by chiasmal compression.

A pilot study of combined optical coherence tomography and diffusion tensor imaging method for evaluating microstructural change in the visual pathway of pituitary adenoma patients

Background

RNFL thickness measured by optical coherence tomography (OCT) and visual pathway measured by diffusion tensor imaging (DTI) can be used to predict visual field recovery, respectively. However, the relationship between RNFL thickness and visual pathway injury in patients with pituitary adenoma (PA) remains unclear. This study aims to evaluate the combining DTI and OCT methods in observing the microstructural change in the visual pathway in patients with PA.

Methods

Twenty-nine patients who were diagnosed with PA were included in the study group, and 29 healthy subjects were included as the control group. OCT detected the thickness of circumpapillary retinal nerve fiber layer (CP-RNFL) and ganglion cell layer (GCL). DTI measured the values of fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Correlation between CP-RNFL and GCL thickness and FA and ADC values was analyzed in the study group.

Results

Compared with the control group, the FA values of the bilateral optic nerve, chiasma, bilateral optic tract, and left optic radiation in the study group were reduced, and the ADC values of the bilateral optic nerve and optic chiasma were increased. Correlation analysis showed that the FA value of the optic chiasma was positively correlated with the average thickness of RNFL, the CP-RNFL thickness in the nasal and temporal retinal quadrants in both eyes, as well as the thickness of macular ring GCL in the nasal, supra, and inferior quadrants. The FA values of the optic nerve, optic chiasma, optic tract, and optic radiation were positively correlated with CP-RNFL thickness in the nasal and temporal quadrants.

Conclusion

Combined DTI and OCT can provide a comprehensive understanding of the microscopic changes in the structure and function of the whole visual pathway in patients with PA.

Diagnostic and Prognostic Utility of Optical Coherence Tomography in Patients with Sellar/Suprasellar Lesions with Chiasm Impingement: A Systematic Review/ Meta-Analyses

BACKGROUND

In this review, we appraised the current literature on the utility of optical coherence tomography (OCT) as a diagnostic and predictive factor for postoperative visual function outcomes in patients with sellar/suprasellar lesions with chiasmal impingement.

METHODS

A systematic search of PubMed, CINAHL, Scopus, and Cochrane Library was conducted following PRISMA guidelines. Included studies described diagnostic or prognostic utility of OCT in patients with sellar/suprasellar lesions with chiasmal impingement. Meta-analysis was represented with mean difference (MD) with 95% confidence intervals. Meta-regression was performed to determine predictive factors of visual outcomes.

RESULTS

Forty-eight articles were identified for final pooled analysis, representing a total of 2,435 patients with compressive sellar/suprasellar lesions and 952 healthy controls. Mean age was 43.3(11.4) years, with 1,494(48.8%) male and 1,566(51.2%) female patients. Mean retinal nerve fiber layer(RNFL) was significantly different in the study population compared to healthy controls(75.8μ[13.2] vs 91.4μ[10.8], p<0.00001). The nasal segment of RNFL had the largest mean difference (MD -9.76[-12.39, -7.13], p<0.0001). Visual acuity, visual field mean deviation (VF-MD), and visual field pattern standard deviation, all showed significant differences between the study population and healthy controls as well(p<0.0001). Meta-regressions showed significant predictive capability of preoperative RNFL in determining visual function outcome (p<0.05).

CONCLUSION

Our findings provide promising support for the growing evidence that OCT parameters can be utilized as both a diagnostic and prognostic tool for patients with compression of the optic apparatus. There is a need for further studies to gain a better understanding of OCTs and to improve patient outcomes.

TBX15 rs98422, DNM3 rs1011731, RAD51B rs8017304, and rs2588809 Gene Polymorphisms and Associations With Pituitary Adenoma

BACKGROUND

Pituitary adenoma (PA) is a benign tumor of parenchymal cells in the adenohypophysis, and it's development is strongly associated with genetic factors.This study aim was to find whether TBX15 rs98422, DNM3 rs1011731, RAD51B rs8017304, and rs2588809 single nucleotide polymorphisms can be associated with pituitary adenoma. While the TBX15 gene belongs to the T-box family of genes and is a transcription factor involved in many developmental processes, the DNM3 encodes a protein that is a member of the dynamin family with mechanochemical properties involved in actin-membrane processes, predominantly in membrane budding, and the RAD51B gene plays a significant role in homologous recombination in DNA repair for genome stability.

MATERIALS AND METHODS

The study enrolled 113 patients with pituitary adenoma and 283 healthy control subjects. DNA samples were extracted and purified from peripheral blood leukocytes. Genotyping was carried out using real-time polymerase chain reaction. The results were assessed using binomial logistic regression.

RESULTS

Our study revealed that RAD51B rs2588809 TT genotype could be associated with PA development in the co-dominant (OR=6.833; 95% CI=2.557-18.262; p<0.001) and recessive (OR=7.066; 95% CI=2.667-18.722; p<0.001) models. The same results were observed in females but not in males and PA without recurrence, while in PA with recurrence, no statistically significant results were obtained.

CONCLUSION

RAD51B rs2588809 TT genotype may increase the odds of PA development in women; it may also be associated with non-recurrent PA development.

Retinal microvasculature in pituitary adenoma patients: is optical coherence tomography angiography useful?

PURPOSE

To examine retinal vascular changes in the peripapillary and macular areas in patients with pituitary adenoma (PA) using optical coherence tomography angiography (OCTA).

METHODS

Cross-sectional, retrospective study of 17 consecutive PA patients and 16 healthy subjects. All patients underwent a neuro-ophthalmological examination to assess the presence of optic neuropathy (ON). Static automated perimetry (SAP), macular and optic disc structural OCT [retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) thicknesses] and OCTA were performed. Pituitary adenoma (PA) patients with ON were compared to those without ON and to healthy subjects.

RESULTS

Optic neuropathy (ON) was found in 16 eyes of nine PA patients. Peripapillary vessel density (ppVD) and macular vessel density (VD) in the superficial vascular plexus were significantly decreased in PA eyes with ON, compared to healthy eyes (45.21 ± 5.69 versus 50.52 ± 2.14% and 43.79 ± 5.03% versus 48.96 ± 2.94%, respectively). No significant difference in VD was observed in the macular deep vascular complex (DVC) between groups. Pituitary adenoma (PA) patients with ON had a mean ppVD reduction by 10.51% compared to healthy subjects. RNFL and GCC thicknesses were significantly reduced in PA eyes with ON compared to the other groups. Peripapillary VD (ppVD) significantly correlated with RNFL thickness and SAP mean deviation.

CONCLUSIONS

Optical coherence tomography angiography showed a significant decrease in ppVD and superficial macular VD in PA eyes with ON compared to healthy eyes, according to RNFL and GCC thinning. Together with the absence of DVC alterations, it may provide further insights into neurovascular coupling.

Primary visual cortical thickness in correlation with visual field defects in patients with pituitary macroadenomas: a structural 7-Tesla retinotopic analysis

OBJECTIVE

Vision loss remains a debilitating complication of pituitary adenomas, although there is considerable variability in visual impairment before and after decompression surgery. Growing evidence suggests secondary damage to remote visual structures may contribute to vision loss in patients with chiasmatic compression. The present study leverages ultrahigh field 7-T MRI to study the retinotopic organization of the primary visual cortex (V1), and correlates visual defects with cortical thinning in V1 to characterize consequences of pituitary adenomas on the posterior visual system.

METHODS

Eight patients (4 males and 4 females, mean age 44.3 years) with pituitary adenomas who exhibited chiasmatic compression and visual field defects, as well as 8 matched healthy controls (4 males and 4 females, mean age 43.3 years), were scanned at 7-T MRI for this prospective study. Whole-brain cortical thickness was calculated using an automated algorithm. A previously published surface-based algorithm was applied to associate the eccentricity and polar angle with each position in V1. Cortical thickness was calculated at each point in the retinotopic organization, and a cortical thickness ratio was generated against matched controls for each point in the visual fields. Patients with adenoma additionally underwent neuroophthalmological examination including 24-2 Humphrey automated visual field perimetry. Pattern deviation (PD) of each point in the visual field, i.e., the deviation in point detection compared with neurologically healthy controls, was correlated with cortical thickness at corresponding polar and eccentricity angles in V1.

RESULTS

Whole-brain cortical thickness was successfully derived for all patients and controls. The mean tumor volume was 19.4 cm3. The median global thickness of V1 did not differ between patients (mean ± SD 2.21 ± 0.12 cm), compared with controls (2.06 ± 0.13 cm, p > 0.05). Surface morphometry-based retinotopic maps revealed that all 8 patients with adenoma showed a significant positive correlation between PD and V1 thickness ratios (r values ranged from 0.31 to 0.53, p < 0.05). Mixed-procedure analysis revealed that PD = -8.0719 + 5.5873*[Median V1 Thickness Ratio].

CONCLUSIONS

All 8 patients showed significant positive correlations between V1 thickness and visual defect. These findings provide retinotopic maps of localized V1 cortical neurodegeneration spatially corresponding to impairments in the visual field. These results further characterize changes in the posterior visual pathway associated with chiasmatic compression, and may prove useful in the neuroophthalmological workup for patients with pituitary macroadenoma.