Visual outcome of blind eyes in pituitary apoplexy after transsphenoidal surgery: a series of 14 eyes

Surg Neurol. 2005 Jan;63(1):42-6; discussion 46. doi: 10.1016/j.surneu.2004.03.014.

Abstract

Background: To study the visual outcome of patients who became blind after an episode of pituitary apoplexy and who subsequently underwent emergency transsphenoidal decompression of the optic apparatus, and to identify factors that may have a bearing on the visual outcome in such patients.

Methods: Twenty-three patients underwent transsphenoidal surgery for pituitary apoplexy over a 5-year period at the All India Institute of Medical Sciences. Among them, 8 (35%) presented with visual deterioration to monocular (n = 2) or binocular (n = 6) blindness after the apoplectic episode. There were 7 males and 1 female with the average age of patients being 43 years. The mean delay between the apoplexy and neurosurgical consultation was 10 days, with a range of 4 to 30 days. The adenoma was classified as "giant" in 4 and multicompartmental in 2 patients. After surgery, all patients had a minimum follow-up of 3 months.

Results: Four patients (50%) had improvement in vision to greater than 2/60 (Snellen's), including 2 patients whose vision improved to 6/6. All patients in whom there was improvement in vision had been operated on within a week of the apoplectic episode.

Conclusions: This study shows that even completely blind eyes may have remarkable improvement in vision if surgical decompression of the optic apparatus is undertaken early. Awareness regarding pituitary apoplexy and reversibility of vision loss needs to be increased among the medical community, especially ophthalmologists and physicians, so that timely neurosurgical intervention can occur.

MeSH terms

  • Adenoma / complications*
  • Adenoma / pathology
  • Adenoma / physiopathology
  • Adult
  • Blindness / etiology
  • Blindness / physiopathology
  • Blindness / surgery*
  • Decompression, Surgical / methods
  • Decompression, Surgical / statistics & numerical data
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Nerve Compression Syndromes / etiology
  • Nerve Compression Syndromes / physiopathology
  • Nerve Compression Syndromes / surgery*
  • Neurosurgical Procedures / methods
  • Neurosurgical Procedures / statistics & numerical data
  • Optic Chiasm / diagnostic imaging
  • Optic Chiasm / injuries
  • Optic Chiasm / pathology
  • Optic Neuropathy, Ischemic / etiology
  • Optic Neuropathy, Ischemic / physiopathology
  • Optic Neuropathy, Ischemic / surgery*
  • Pituitary Apoplexy / etiology
  • Pituitary Apoplexy / physiopathology
  • Pituitary Apoplexy / surgery*
  • Pituitary Gland / diagnostic imaging
  • Pituitary Gland / pathology
  • Pituitary Gland / surgery
  • Pituitary Neoplasms / complications*
  • Pituitary Neoplasms / pathology
  • Pituitary Neoplasms / physiopathology
  • Sphenoid Bone / diagnostic imaging
  • Sphenoid Bone / pathology
  • Sphenoid Bone / surgery
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome