Neuro-Ophthalmological Changes in Patients with Aggressive Pituitary Adenomas

Objective. To study the prevalence and structure of visual field defects in patients with aggressive pituitary adenomas (APA) and determine their correlation with tumor size.

Material and methods. The study included 48 patients with a confirmed diagnosis of APA and 32 patients with pituitary macroadenomas without signs of aggressive progression (control group). All patients underwent neuroimaging studies (MRI) and computerized perimetry. The frequency and structure of visual field defects, as well as MD (Mean Deviation) and PSD (Pattern Standard Deviation) indicators, were analyzed.

Results. Abnormal visual fields were detected in 81.3% of patients with APA, compared to 40.6% in the control group (p<0.0003). The most common defect was bitemporal hemianopia (31.3% vs. 12.5%, p<0.05). Bilateral visual field defects were significantly more frequent in patients with APA (62.5% vs. 21.9%, p<0.0005). Patients with APA showed significantly greater changes on computerized perimetry: MD (-9.8±3.5 dB) and PSD (6.4±2.1 dB) compared to -3.3±1.8 dB and 2.5±1.3 dB in the control group (p<0.0001). The analysis revealed significant thinning of the retinal nerve fiber layer (RNFL) in patients with APA particularly in the temporal and nasal sectors. The most pronounced changes were observed in the temporal sector (p<0.0001). A strong correlation was established between tumor volume and the degree of optic chiasm compression (r=-0.71, p<0.0001).

Conclusion. Patients with APA exhibit pronounced neuro-ophthalmological impairments, including bitemporal hemianopia, significant MD reduction, increased PSD, and thinning of the retinal nerve fiber layer (RNFL).

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