Factors influencing improvement of visual field after trans-sphenoidal resection of pituitary macroadenomas: a retrospective cohort study.

AIM: To investigate the influencing factors of visual field improvement after trans-sphenoidal resection of pituitary macroadenomas. METHODS: This retrospective cohort study included 201 patients (366 eyes) with visual field defect induced by pituitary macroadenomas. All of them were treated with trans-sphenoidal surgery. Ophthalmologic evaluation, best-corrected visual acuity (BCVA), and visual field examination were performed before and 3mo after surgery. BCVA, visual field defect index mean deviation (MD), duration of symptoms, age, sex, and volume of tumors were compared. Expression of vascular endothelial growth factor (VEGF) and Ki-67 of tumor tissue were detected by immunohistochemical technique. RESULTS: The mean age of patients was 44.23±1.29y. Ninety-three patients were female and 108 were male. The mean tumor volume was 14.36±6.23 cm(3). The mean duration of preoperative symptoms was 11.50±0.88mo. Mean preoperative MD was -17.50±0.82 dB. Mean Preoperative visual acuity was 0.64±0.04. Postoperative visual field improved in 270 (73.77%) eyes, unchanged in 96 (26.23%) eyes. Multivariate logistic regression displayed that the factors independently influencing visual field improvement were young age (OR=1.71, 95%CI: 1.325-2.387, P=0.013), low preoperative MD absolute value (OR=1.277, 95%CI: 1.205-1.355, P<0.001), small volume of tumor (OR=1.458, 95%CI: 1.060-4.289, P<0.001), low expression of VEGF in tumor tissue (OR=1.554, 95%CI: 1.089-2.457, P=0.022), and low expression of Ki-67 in tumor tissue (OR=1.552, 95%CI: 1.161-2.847, P=0.026). CONCLUSION: After pituitary macroadenomas trans-sphenoidal resection, the independent influencing factors of the visual fields recovery were low preoperative MD absolute value, young age, small volume of tumor, and expression levels of VEGF/ Ki-67.

Rehabilitation of vision disorder and improved quality of life in patients with primary open angle glaucoma.

BACKGROUND: Primary open angle glaucoma (POAG) is a common cause of irreversible blindness. The variable etiology of POAG poses significant challenges for treatment and rehabilitation. We analyzed a large POAG patient cohort during treatment to reveal possible causes of vision disorder, assess vision-related quality of life (VRQL), and to evaluate the efficacy of rehabilitative treatments. METHODS: We analyzed the visional disturbances in 500 POAG patients (890 eyes) by regular ophthalmic examination and visual field examination using Humphrey 30° perimetry. Appropriate rehabilitative treatments for POAG were prescribed based on results of clinical examination and included correction of ametropia, health education, counseling, and the fitting of typoscopes. VRQL was assessed before and after treatment by a VRQL self-assessment questionnaire. RESULTS: Scores on the VRQL self-assessment were significantly lower compared to healthy controls. The primary cause of the vision disturbances was ametropia (97.99%), and 51.61% of the ametropia eyes had not received appropriate correction. The secondary causes of visual impairment were glaucomatous neurodegeneration (26.29%), complicated cataract, or other accompanying eye diseases. The causes of the clinical low vision (44 patients) were glaucomatous neurodegeneration (32 eyes), fundus diseases (23 eyes), keratopathy (11 eyes), and other eye diseases (10 eyes). The VRQL scores of patients improved significantly after rehabilitation and the correction of ametropia (P < 0.01). Twenty-five patients with low vision were provided with typoscopes, and 21 (84%) experienced significant functional recovery, while the remaining low vision patients could see letter lines two or more levels lower (smaller) on visual charts in a near vision test. CONCLUSIONS: Vision disorders in POAG patients are common and severe. Appropriate rehabilitation, especially the correction of ametropia, can significantly improve VRQL as revealed by the self-assessment of POAG patients.

[Ophthalmic manifestations of Wilson's disease].

OBJECTIVE: To investigate the ophthalmic manifestations of Wilson's disease (WD). METHODS: In this nonrandomized retrospective case series, fifty-two WD patients were investigated retrospectively, based on the family history, clinical signs and the laboratory test Patients were divided into 4 groups: asymptomatic group, only with hepatic disorders, only with neurological disorders and with both hepatic and neurological disorders group. RESULTS: Thirty two males and twenty females were studied. The ratio of male to female was 1.6:1.0. The mean age was (20 +/- 1) years, ranged from 4 to 53 years. The majority (78.8%) of patients belonged to younger age groups (10-30 years). The family history showed members with WD in 14 patients (26.9%), probable WD in 3 patients (5.8%). Out of 52 patients, 2 asymptomatic patients (3.8%) were detected by family screening, 12 patients (23.1%) only had hepatic disease, 11 patients (21.2%) only had neurological disorders and 27 patients (51.9%) had both hepatic and neurological disorders. Among 45 patients (86.5%) with Kayser-Fleischer (K-F) ring, 1 patient was asymptomatic, 7 patients had hepatic disease, 11 had neurological disorders and 26 had both hepatic and neurological disorders. One patient (1.9%) was presented with sunflower cataract. Fifty one patients (98.1%) had low serum ceruloplasmin levels and high urinary copper excretion. CONCLUSIONS: K-F ring is a common and characteristic manifestation of WD. This is often found in patients with neurological disorders.