| BACKGROUND:Pituitary adenoma is an interdisciplinary subject of Ophthalmology and Neurosurgery,which affects the structure and function of the optic pathway.It has typical and varied eye symptoms and signs.Many of these patients will have eye symptoms and even first visit ophthalmology.Because of the obvious visual loss and visual field defect,it is easy to be misdiagnosed as ophthalmic diseases such as glaucoma and optic neuritis.Once the treatment is delayed due to misdiagnosis,the damage of visual function and body function caused by pituitary adenoma is very serious,and may be even blindless or fatal.The ocular manifestations of patients are also important indicators to evaluate the severity of pituitary tumor and determine whether the operation is necessary.In addition,visual acuity,visual field and other ophthalmic examinations are also of great significance in predicting the prognosis of the disease.Pituitary tumors are classified into functioning pituitary adenoma(FPA)and nonfunctioning pituitary adenoma(NFPA)according to whether or not synthesizing and secreting bioactive hormone.Does the clinical characteristics and the degree of visual impairment of pituitary adenoma depend on the nature,size or location of the tumor?At present,there is no study focus on the differences of visual impairment between functioning and nonfunctioning pituitary adenoma.OBJECTIVE:To discuss the clinical characteristics and visual function damage of pituitary adenoma patients in detail,and to compare the clinical features and visual impairment of functioning and nonfunctioning pituitary adenoma patients,so as to provide scientific basis for clinical diagnosis,treatment and follow-up.METHODS:The patients with first diagnosis of pituitary adenoma and underwenting the surgery of transcranial or transnasal sphenoid endoscopic resection from September 2016 to December 2019 in Neurosurgery Ward-of our hospital were collected.We collected the basic information of the patients,including sex,age,type of tumor,first symptom,vision,visual field and tumor size.The sex ratio,age,onset time and first symptom of the two groups were compared.The vision and visual field defects of FPA and NFPA were compared.The relationship between vision loss and visual field loss were analysed.The types of visual field defects in FPA and NFPA groups were compared.The correlation between tumor size and visual field defect was analyzed.The correlation factors of vision,visual field return and prognosis were analyzed in both groups.RESULTS:1.Basic data:a total of 208 patients were included in this study,with 50 men and 54 women.The age was 15?74 years(48.41±13.36 years old),and the median age was 50 years old.The shortest time of onset was 7 days,the longest was 6 years,the median was 180 days,and the average time was 374.61 days.The first symptoms presented in the eyes in 32 patients,accounting for 30.8%;the nervous system in 31 patients;the endocrine system in 24 patients;17 patients were found by physical examination.The best corrected visual acuity was 0.31±0.54.MD value was 11.57±8.39(dB).MS value was 16.49±8.48(dB).Transverse diameter of tumor was 2.40 ± 0.99 cm,anteroposterior diameter was 2.05 ± 0.96 cm,craniocaudal diameter was 2.22 ±1.02 cm,and the volume was 8.17±9.37 cm3.2.The comparison of the two groups:there were 21 men and 29 females in FPA group,29 men and 25 females in NFPA group.There was no significant difference between the two groups(P=0.233).The median age of FPA group(43 years old)was significantly lower than that of NFPA group(53 years old)(P<0.001).The median onset time of FPA group was 588.21 days,which was significantly longer than that of NFPA group on 263.06 days(P=0.003).There were fewer patients with the first symptoms presented in the eyes in FPA group than that in NFPA group(P=0.049),but the same who has eye symptoms between the two groups(P=0.057).3.Visual impairment:the best corrected visual acuity of FPA group(0.17±0.35)was better than that of NFPA group(0.44±0.65)(P=0.002).The proportion of most severe damage was higher in NFPA group.The average MD value of FPA group was lower than that of NFPA group,the average MS value of FPA group was higher than that of NFPA group,indicating that the visual field damage degree of FPA group was slighter than that of NFPA group.The proportion of most severe damage was higher in NFPA group.Among the types of single eye visual field defects,FPA group saw the most of total sensitivity decline,followed by temporal hemianopia breaking through vertical midline;NFPA group saw the most of them were temporal hemianopia breaking through vertical midline.Among the types of bilateral visual field defects,FPA group saw the most common type of bilateral sensitivity decline and bilateral temporal hemianopia,while NFPA group saw the most common type of bilateral temporal hemianopia.There are patients with the defect of nasal visual field in both groups,and one case of binasal hemianopsia was also found in each group.4.The relationship between vision loss and visual field defect:The vision and visual field defects are not completely synchronized in the group.There are 45 eyes had vision impairment,24 eyes had no vision impairment in FPA group with visual field defect;70 eyes had vision impairment,17 eyes had no vision impairment in NFPA group with visual field defect.The difference was statistically significant(?2=4.614,P=0.032).There are 45 eyes had visual field defect and 7 eyes had no visual field defect in the FPA group with vision loss;70 eyes had visual field defect,4 eyes had no visual field defect in NFPA group with vision loss.There was no statistical significance(x2=2.488,P=0.115).It shows that the proportion of vision impairment in NFPA group with visual field defect is higher than that of FPA group,while in the patients with vision loss,the proportion of visual field defect is equal to that of the two groups.5.The correlation between tumor size and visual field defect:The anteroposterior diameter of the tumour was significantly smaller in the FPA group(P=0.013).There was no significant difference in the transverse or craniocaudal tumour diameter between the two groups.The mean tumour volume of the FPA group(6.16±6.52 cm3)was significantly smaller than that of the NFPA group(9.62±10.64 cm3)(t=-2.088,P=.039).It was found that the tumour size was significantly and positively correlated with the MD and negatively correlated with the MS in both groups.6.Postoperative outcome:of all patients,31 patients had eye examination in the early postoperative period,of which 16 patients in FPA group and 15 patients in NFPA group.The MD of the two groups was significantly lower and the MS was significantly higher than that before operation,indicating that the visual field defects of both groups recovered after operation.The visual field of FPA group was unchanged in 6 eyes,improved in 21 eyes,deteriorated 5 eyes.It was unchanged in 9 eyes,improved in 21 eyes,no case of visual field deterioration in NFPA group.Only the patients with visual field defect deterioration were more in FPA group than that in NFPA group(P=0.024).Twenty-eight patients with visual function impairment who had eye examination in the early postoperative period were divided into the improvement group and non-improvement group.The results showed that the time of onset in non-improvement group was significantly longer than that in the improvement group(P=0.049).The anteroposterior diameter?craniocaudal diameter and the volume of the tumor were significantly higher in non-improvement group than that in improvement group(P<0.05).Logistic regression analysis showed that the time of onset(OR=0.998,P<0.05)and tumor volume(OR=0.29,P<0.05)were negatively correlated with the improvement of postoperative visual function;the tumor diameter(OR=51.58,P<0.05)was positively correlated with the improvement of postoperative visual function.CONCLUSIONS:1.There was no gender difference between FPA group and NFPA group;the age of onset in FPA group was lower than that of NFPA group;the delay time of diagnosis in FPA group was longer than that of NFPA group;there were fewer patients with the first symptoms presented in the eyes in FPA group than that in NFPA group,but the same who has eye symptoms between the two groups.2.The vision and visual field defect in NFPA group was more serious than FPA group,mainly the proportion of severe damage was higher in NFPA group;the typical visual field defects in both groups were temporal hemiblind,but there were also non typical visual field defects.3.The vision and visual field defect of pituitary tumor patients are inconsistent.Most patients have earlier visual field defects than vision impairment.4.The larger the volume of pituitary tumor,the more serious the visual field defect.The anteroposterior diameter and the volume of the tumour was significantly smaller in the FPA group.5.The visual field defects of the two groups recovered after operation.Whether functioning or nonfunctioning was not significantly related to postoperative outcome.The longer the onset time and the larger the tumor volume,the less likely the postoperative visual function is to improve;the larger the preoperative tumor height is,the easier the postoperative visual function is to improve.6.In FPA,the degree of visual impairment caused by multi hormone adenoma and growth hormone tumor is less than that of other types. |
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