ABSTRACT
BACKGROUND: With pituitary macroadenomas, there is a high incidence of visual loss from optic pathway compression. Surgical removal of the tumor usually prevents progression and allows visual recovery. Our objective was to evaluate if optical coherence tomography (OCT) predicts visual outcomes after surgical decompression. METHODS: Patients with pituitary macroadenomas were prospectively recruited between February 2015 and November 2016. We evaluated preoperative and postoperative visual acuity, automated perimetry, and OCT. We compared the results 6-12 weeks and 6-9 months after surgical removal of the tumor. Dependent and independent continuous variables were analyzed by Student's t-test, linear regression analysis, and Pearson's correlation coefficients, considering P < 0.05 as statistically significant. RESULTS: Visual acuity and visual field defects were much worse in patients with a thin preoperative retinal nerve fiber layer (RNFL). Both patients with normal RNFL thickness and patients with thin RNFL experienced significant improvement in postoperative visual perimetry 6-12 weeks after surgery. OCT values correlated inversely with pre- and postoperative visual fields, which means that, if the nerve was thicker, the visual field was better. Patients with a normal OCT had greater recovery because their preoperative perimetry values were better. The correlation between OCT values and visual field improvement was weak, suggesting that patients' visual fields improved after decompressive surgery independent of the nerve's thickness. CONCLUSION: The computerized visual field continues to be the gold standard in the evaluation of patients with pituitary macroadenomas with optic pathway compression. Our results suggest that OCT might not be an accurate predictor of visual outcomes.
ABSTRACT
El síndrome de leucoencefalopatía posterior reversible se presenta con síntomas de edema cerebral e imágenes hiperintensas en las secuencias T2 y FLAIR en la resonancia magnética (RM) de cerebro. Las lesiones típicamente comprometen la región parietooccipital, aunque también pueden tener localizaciones atípicas. Presentamos el caso de una mujer de 33 años que consultó por trastornos visuales asociados con dolor de cabeza intenso e hipertensión grave (220/140 mmHg). El examen del fondo de ojo reveló retinopatía hipertensiva grado IV y la RM mostró lesiones hiperintensas en T2 y FLAIR a nivel centropontino, bulbo y médula espinal, las cuales regresaron tras el control sostenido de la presión arterial. (AU)
The posterior reversible leukoencephalopathy syndrome presents with symptoms of cerebral edema. On magnetic resonance imaging (MRI) of the brain, hyperintensities on T2 -weighted and FLAIR sequences typically affect the parietal-occipital region; however it may also have atypical locations. We report the case of a 33 year old patient with visual disturbances associated with intense headache and severe hypertension (220/140 mmHg). The Fundus examination revealed grade IV hypertensive retinopathy, and MRI showed hyperintense lesions in T2 and FLAIR affecting the pontine center, medulla and spinal cord, which regressed after sustain blood pressure control. (AU)
