Characteristics of Preoperative Visual Disturbance and Visual Outcome After Endoscopic Endonasal Transsphenoidal Surgery for Nonfunctioning Pituitary Adenoma in Elderly Patients

Background: Pituitary adenomas in elderly patients may become more common as the population ages. Surgical benefits, especially for visual outcome, after endoscopic endonasal transsphenoidal surgery for pituitary adenomas remain to be elucidated. This retrospective analysis investigated clinical factors affecting visual outcome.

Methods: The study included 35 patients with nonfunctional pituitary adenomas who underwent surgery and were subdivided into elderly (≥70 years old, n = 12) and younger (<70 years old, n = 23) groups for analysis. Clinical characteristics and preoperative and postoperative visual function evaluated using visual impairment score (VIS) were compared between groups.

Results: Mean age at diagnosis was 75.1 ± 1.5 years in the elderly group and 55.5 ± 2.0 years in the younger group. VIS was improved in 91% of elderly patients and 80% of younger patients, but postoperative VIS remained higher in elderly patients. Preoperative VIS and incidence of previous cataract surgery were significantly higher in elderly patients than in younger patients. Preoperative and postoperative VISs were significantly correlated with age. Preoperative VIS was significantly higher in patients with previous cataract surgery and correlated with postoperative VIS.

Conclusions: Visual disturbances were improved postoperatively in most patients in both groups at similar rates, but preoperative and postoperative visual disturbances were more severe in elderly patients because the symptoms may have been masked by the presence of lens opacity. Early diagnosis and intervention may be required in elderly patients for better visual outcome.