Predictors of visual outcomes in urgent or delayed pituitary macroadenoma resection

Abstract Purpose: Visual recovery after pituitary macroadenoma decompression is unpredictable. We sought to identify clinical and radiologic predictors of visual recovery and explore visual outcomes in patients who underwent early versus late surgery. Methods: Retrospective study of patients with pituitary macroadenomas approaching/contacting the chiasm at a tertiary neuro-ophthalmology practice. Clinical/demographic/MRI data was analyzed. Patients who were observed or received surgery after 1 year were identified. A final visual acuity (VA) of at least 20/40 and a final visual field mean deviation (VF MD) of -5dB or better were defined as positive outcomes. Results: 68 patients were included. Patients with positive VA outcomes had better preoperative VA (logMAR 0.3 vs 1.3), VF MD (-8.1dB vs -17.9dB), thicker retinal nerve fiber layer (RNFL) (81.9µm vs 69.5µm) and ganglion cell complexes (GCC) (69.0µm vs 50.5µm) than those without. VF outcomes were predicted by better preoperative VA (logMAR 0.3 vs 0.7), VF MD (-7.4dB vs -14.5dB), thicker RNFL (84.1µm vs 70.5µm) and GCC (71.2µm vs 55.6µm) measurements, and tumour volume (8.4cm³ vs 18.2cm³). 30 patients with better VA (logMAR 0.2 vs 0.7), VF MD (-3.97dB vs -12.61dB), thicker RNFL (88.7µm vs 76.5µm), and GCC (74.3µm vs 64.6µm) measurements had surgery deferred. Visual outcomes were similar compared to those who had surgery within a year. Conclusion: Preoperative VA/VF MD/RNFL/GCC thickness may predict visual outcomes after pituitary macroadenoma resection. Future studies are required to evaluate the safety of deferring surgery, even with favourable preoperative visual parameters.