| Purpose To analyze quantitative changes of macular ganglion cell complex(mGCC),peripapillary retinal nerve fiber layer(pRNFL)thickness and superficial retinal capillary plexus(SRCP),radial peripapillary capillary(RPC)vessel density in patients with chiasmal compression due to sellar region mass using optical coherence tomography angiography(OCTA)and its potential value for clinical diagnosis,disease assessment,and prediction of visual prognosis.Methods This is a prospective longitudinal observational study that enrolled 66 patients with chiasmal compression due to sellar region mass at the department of neurosurgery in the First Affiliated Hospital of Anhui Medical University from September 2021 to April 2022.42 patients who met the inclusion exclusion criteria were included in the observation group,among them 21 patients were male and 21 patients were female,age ranged from 21 to 75(49.7±11.4)years.In the observation group,24 eyes of 24 patients who had visual field defects were included in the visual field defect group,and 18 eyes of 18 patients who did not have visual field defects were included in the normal visual field group,42 healthy subjects whose gender and age matched those in observation group were included in the healthy control group.A further 24 patients underwent optic chiasmal decompression surgery and followed up in outpatient clinics at 1 and 4-6 months postoperatively were enrolled as surgery group.Among them 10 patients were male and14 patients were female,ranged from 25 to 68(50.7±11)years,and both eyes were included in analysis.Visual acuity,visual field and OCTA were performed in all participants.The thickness of mGCC and pRNFL,and the vessel density of the SRCP and RPC were quantitatively assessed using OCTA.Covariance analysis were used to compare mGCC,pRNFL thickness and RPC,SRCP vessel density among the visual field defect group,the visual field normal group and the healthy control group.Spearman’s correlation analysis was used to investigate the relationship between RPC,SRCP vessel density and GCC,pRNFL thickness,visual acuity,visual field in patients with chiasmal compression.Multiple linear regression was used to investigate the influencing factors of retinal vessel density in patients with with chiasmal compression.ROC curves were used to assess the diagnostic efficacy of mGCC,pRNFL thickness and SRCP,RPC vessel density for chiasmal compression.The generalized estimating equation was used to compare mGCC,pRNFL thickness and SRCP,RPC vessel density at different time points before and after surgery.Logistic regression models were used to assess the predictive value of pRNFL,GCC thickness and RPC,SRCP vessel density on visual field recovery after decompression,and to calculate the Youden-optimal cut-off value.Results Compared with healthy controls,patients in the visual field defect group showed significant reduced mGCC,pRNFL and RPC,SRCP vessel density(all P<0.05).Patients in the visual field normal group had no statistical differences in mGCC,pRNFL thickness and RPC,SRCP vessel density compared with healthy controls(all P>0.05).In the observation group,RPC and SRCP vessel density had a positive correlation with mGCC and pRNFL thickness(all P<0.05)and a negative correlation with the degree of visual field defects and best corrected visual acuity(all P<0.05).The change of mGCC thickness had a significant effect on SRCP vessel density and the change of pRNFL thickness had a significant effect on RPC vessel density in the observation group(all P<0.05).The AUC values of pRNFL thickness,mGCC thickness,RPC vessel density,and SRCP vessel density for the diagnosis of chiasmal compression due to Sellar region mass were 0.767,0.756,0.707,and 0.702,respectively(all P<0.05).The AUC values for the diagnosis of chiasmal compression with normal visual fields were 0.539,0.530,0.416,and 0.561,respectively(all P>0.05).Compared with preoperative values,Postoperative 4-6 months mGCC,pRNFL thickness and SRCP,RPC vessel density were reduced(all P<0.05).The segments with the highest predictive value for visual field recovery after decompression of mGCC,pRNFL,SRCP,and RPC were the superior mGCC,temporal inferior pRNFL,nasal SRCP,and temporal inferior RPC,the AUC values of them were 0.866,0.825,0.718,and 0.824(all P<0.05),respectively.The predictive values of superior mGCC,temporal inferior pRNFL and temporal inferior RPC showed no statistical difference(all P >0.05),and the predictive value of nasal SRCP was lower than that of superior mGCC,temporal inferior pRNFL and temporal inferior RPC(all P<0.05).The Youden-optimal cut-off value in the superior GCC,temporal inferior pRNFL,nasal SRCP,and temporal inferior RPC were 92.5 μm,57.5 μm,43.8%,and 48.9%,respectively.Conclusion OCTA allows quantitative assessment of retinal structure thickness and vessel density,and can be valuable in the diagnosis,disease assessment,and prediction of visual prognosis in chiasmal compression due to sellar region mass. |
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