Optical coherence tomography retinal ganglion cell complex analysis for the detection of early chiasmal compression
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To report patients with sellar tumors and chiasmal compression with normal visual fields, who demonstrate damage to the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) on optical coherence tomography (OCT).
Seven patients with sellar tumors causing mass effect on the optic chiasm without definite visual field defect, but abnormal GCC are described. GCC/RNFL analyses using Cirrus-OCT were classified into centiles based on the manufacturer’s reference range.
In seven patients with radiologic compression of the chiasm by a sellar tumor, OCT-GCC thickness detected compressive chiasmopathy before visual defects became apparent on standard automated visual field testing. Without OCT, our patients would have been labelled as having normal visual function and no evidence of compressive chiasmopathy. With only OCT-RNFL analysis, 3/7 patients would still have been labelled as having no compression of the anterior visual pathways.
These patients show that OCT-GCC analysis is more sensitive than visual field testing with standard automated perimetry in the detection of compressive chiasmopathy or optic neuropathy. These cases and previous studies suggest that OCT-GCC analysis may be used in addition to visual field testing to evaluate patients with lesions compressing the chiasm.
KeywordsPituitary adenoma Sellar mass Chiasmal compression Optic neuropathy Visual field test Optical coherence tomography Ganglion cell complex analysis
This work was supported in part by an unrestricted departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York, and by NIH/NEI core Grant P30-EY006360 (Department of Ophthalmology). Dr. Biousse received research support from NIH/PHS (UL1-RR025008). Dr. Newman is a recipient of the Research to Prevent Blindness Lew R. Wasserman Merit Award.
Compliance with ethical standards
Conflict of interest
No conflicting relationship exists for any author.
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