A 62-year-old female presented with complaints of blurred vision OU for 3 weeks. Her corrected vision was 6/8.6 in the right eye and 6/60 in the left. Intraocular pressure was 12 mmHg in both eyes. Anterior segment was normal OU. Fundoscopic examination showed a small patch of myelinated nerve fibers over the superior disc margin of the right eye (Fig. 41.1). OCT found nerve fiber loss in the naso-temporal sectors of both eyes, with an average peripapillary retinal nerve fiber layer (RNFL) thickness of 86 μm in the right eye and 67 μm in the left. Decreased thickness of the ganglion cell-inner plexiform layer (GC-IPL) was also noted over bilateral macular regions. There was a special pattern of binasal loss of the GC-IPL (Fig. 41.2), corresponding to bitemporal defects in the visual field (Fig. 41.3). MRI of the brain found a less enhanced lesion (27 × 29 × 26 mm) in the pituitary fossa and suprasellar cistern, compatible with pituitary adenoma (Fig. 41.4). The patient underwent endoscopic transsphenoidal surgery 2 weeks later, and the pathological report indicated gonadotroph adenoma. Prolactin was elevated with a concentration of 46.85 ng/ml (normal range for female: 1.2–29.93). At 15 months postoperatively, her corrected vision improved to 6/6.7 OD and 6/60 OS. However, the peripapillary RNFL and macular GC-IPL progressed to more severe conditions, especially in the left eye due to concurrent maculopathy (Fig. 41.5). The defective visual field also continued to deteriorate in the left eye (Fig. 41.6).
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