Abstract:AIM: To evaluate the early postoperative retinal microstructural changes using optical coherence tomography(OCT)in patients with pituitary adenomas(PA)with different degrees of preoperative optic chiasm compression following endoscopic endonasal transsphenoidal surgery.
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.
