目的：利用光学相干断层扫描(OCT)评估术前视交叉不同受压程度的垂体腺瘤(PA)患者行经鼻内镜下蝶窦手术后早期的视网膜微结构变化情况。

方法：前瞻性队列研究。选取2022年9月至2025年10月我院初次诊断为PA患者65例130眼，根据术前视交叉受压程度分为轻度受压组和重度受压组，两组患者均首次接受经鼻内镜蝶窦手术治疗。比较两组患者手术前后最佳矫正视力(BCVA)、视野(MD)、视网膜微结构变化。

结果：随访期间失访8例16眼，最终纳入57例114眼，其中轻度受压组30例60眼、重度受压组27例54眼。两组患者年龄、性别和病程比较均无差异(P>0.05)。重度受压组患者PA长度、宽度、高度及鞍上高度均大于轻度受压组，视交叉厚度均小于轻度受压组(均P<0.05)。术前和术后1 mo两组患者MD值比较均有差异(均P<0.05)。OCT结果显示相较于术前，轻度受压组术后1 mo颞侧视盘周围神经纤维层(CP-RNFL)增厚，黄斑内环鼻侧及上方、外环鼻侧神经节细胞层(GCL)，内环上方内丛状层(IPL)厚度和内环上方黄斑神经节细胞复合体(mGCC)增加； 内环颞侧及下方GCL厚度，外环上方、内环鼻侧及颞侧IPL层厚度与内环颞侧及下方mGCC厚度相较变薄。而相较于术前，重度受压组黄斑各象限GCL厚度、各象限(除内环颞侧及外环鼻侧)的IPL厚度、各象限(除内环颞侧、外环颞侧及下方)的mGCC厚度均变薄。重度受压组内环鼻侧及上方、外环鼻侧GCL，内环上方及外环颞侧IPL和内环上方mGCC术后早期与术前的变化差值低于轻度受压组(均P<0.05)。

结论：两组患者术后早期的视功能较术前均有不同程度改善，在视网膜微结构上视交叉受压程度更轻的患者术后早期表现出更高的恢复潜力。

METHODS:This was a prospective cohort study. A total of 65 patients(130 eyes)initially diagnosed with PA in the hospital from September 2022 to October 2025 were enrolled. Based on the degree of preoperative optic cross-compression, the patients were divided into mild compression group and severe compression group. Both groups of patients underwent endoscopic endonasal transsphenoidal surgery for the first time.Best-corrected visual acuity(BCVA), mean deviation(MD)of visual field, and retinal microstructural changes between the two groups were compared.

RESULTS:Eight patients(16 eyes)were lost to follow-up during the follow-up period, and a total of 57 patients(114 eyes)were finally included. According to the degree of chiasm compression evaluated by preoperative MRI,it was divided into 30 cases(60 eyes)in the mild compression group and 27 cases(54 eyes)in the severe compression group. There was no difference in the age, gender, and course of the two groups patients(P>0.05). The average length, width, height, and suprasellar extension height of patients in the severe compression group were greater than those in the mild compression group, and theoptic chiasm thickness was smaller than that of the mild compression group(all P<0.05). There was a difference in the MD value of the two groups of patients before and 1 mo after surgery(all P<0.05). OCT results showed that, compared with preoperative findings, the temporal circum papillary retinal nerve fiber layer(CP-RNFL)of the mild compression group was thickened in the early postoperative period, and the thickness of the nasal and superior regions of the inner macular ring, the nasal ganglion cell layer(GCL)of the outer ring, the superior inner plexiform layer(IPL)of the inner ring, and the superior macular ganglion cell complex(mGCC)of the inner ring were increased. The thickness of the temporal and inferior GCL in the inner ring, the superior IPL in the outer ring, the nasal and temporal IPL in the inner ring, as well as the temporal and inferior mGCC in the inner ring were decreased. Compared with preoperative status, the thickness of macular GCL in all quadrants, IPL in all quadrants(except the inner ring temporal and outer ring nasal regions), and mGCC in all quadrants(except the inner ring temporal, outer ring temporal and inferior regions)were reduced in the severe compression group.In terms of postoperative early changes relative to baseline, the difference values of the inner ring nasal and superior GCL, outer ring nasal GCL, inner ring superior and outer ring temporal IPL, as well as inner ring superior mGCC in the severe compression group were significantly lower than those in the mild compression group(all P<0.05).

CONCLUSION:Both groups presents varying degrees of improvement in visual function in the early postoperative period compared with preoperative levels. In terms of retinal microstructures, patients with milder optic chiasm compression demonstrates a greater recovery potential at the early postoperative stage.