垂体腺瘤的眼部改变

垂体腺瘤发病率仅次于胶质瘤和脑膜瘤而居第三位 ,占10 .4%～ 11% ,由于蝶鞍位于颅底 ,远离脑组织和脑室系统 ,如发生肿瘤常缺乏颅内高压征和神经系统体征 ,尤以早期为甚 ,但蝶鞍区是视神经交叉的重要部位 ,早期即可出现视力和视野障碍 ,故一般患者多先就诊眼科 [1 ]。本文总结了 41例垂体腺瘤的眼部改变 ,供眼科和神经外科临床诊治参考。一、临床资料自 1999～ 2 0 0 1年经眼科检查和神经外科手术资料较完整的垂体腺瘤病例 41例 ,其中男 2 4例 ,女 17例 ,年龄在 16～ 78岁。单纯视功能障碍者 11例 ,伴内分泌障碍者 2 1例 ,两者共 3 2例 ,占…     

垂体腺瘤的中心视野与误诊分析

目的 分析垂体腺瘤患者双眼的中心视野及其后极部的眼底改变。 方法 应用Humphrey instruments 750型电脑视野分析仪和TopconTRC-50x眼底照相机，对手术前70例垂体腺瘤患者行全阈值静态中心视野及眼底检查。 结果 视力损害者占64.3%，视野损害者占80.7%，眼底改变者占46.4%。而以视力减退为首诊症状者占45.7%，其中28.6%曾被误诊为眼科疾病。 结论 误诊因素主要是患者以视力减退为首诊症状，且多无视野缺 损主诉及同时伴有眼科疾病症状。因此，在眼科临床诊断过程中，对于原因不明的视力下降和解释不清的视神经萎缩，均应把视野作为常规检查，避免漏诊、误诊。 （中华眼底病杂志，2003，19：18-19）     

垂体肿瘤的眼部改变

１８１例垂体肿瘤中，有视力减退者１２１例（６６．９％），视野缺损者１２５例（６９．１％），视神经萎缩者８３例（４５．９％），视乳头水肿者１１例（６．１％），眼肌麻痹者１３例（７．２％）。以视力减退为首发症状就诊眼科者７９例（４３．６％）。对本病的眼部改变及早期诊断进行了讨论。     

垂体腺瘤视功能损害与误诊分析

垂体腺瘤是较常见的颅内良性肿瘤，因在患病过程中常伴有对视方面的损害而易误诊。通过对２６０例患者的临床观察。其中视力损害者占７２．５％，视野损害者占６３．３％，而以视力减退为首诊症状者占４４．６％，其中２２．４％曾被误诊为眼科疾病，误诊因素主要是患者以视力减退为首诊症状，垂体瘤的全身症状不典型及在患垂体瘤的同时伴有某些眼部疾病，基于上述因素眼科医师在临床诊断过程中对视力，视野异常的患者需要进行综合分     

110例垂体腺瘤的视力和视野检查分析

１１０例垂体腺瘤的视力和视野检查分析沈阳军区总医院眼科蒋志科，兰平垂体腺瘤是常见的颅内肿瘤。其发生率仅次于脑膜瘤、神经胶质瘤，占第三位［１］。由于视交叉和视交叉腹面中央区供血障碍，出现视力减退和视野缺损，故多先就诊于眼科。本文对我院１９８６－１９９４...     

垂体腺瘤视野表现的特征

目的　探讨垂体腺瘤视野表现特征。方法　收集于神经外科经病理确诊为垂体腺瘤的３７１例患者的视野及光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）资料。将垂体腺瘤患者根据视野缺损改变分为颞侧象限性视野缺损组、颞侧垂直性偏盲组和管状视野组。分析视野缺损形态特征,通过线性相关分析及方差分析对视野缺损形态、视野平均光敏感度（ｍｅａｎｓｅｎｓｉｔｉｖｉｔｙ,ＭＳ）等指标与ＯＣＴ测量视网膜神经纤维层（ｒｅｔｉｎａｌｎｅｒｖｅｆｉｂｅｒｌａｙｅｒ,ＲＮＦＬ）厚度、肿瘤体积之间的关系进行分析。结果　颞侧象限性视野缺损组、颞侧垂直性偏盲组和管状视野组三组间ＲＮＦＬ厚度、ＭＳ值差异均具有统计学意义（均为Ｐ＝０．００）,垂体腺瘤体积差异无统计学意义（χ２ ＝０．５８,Ｐ＝０．７５）。颞侧垂直性偏盲组与管状视野组中,ＭＳ和对应眼鼻侧ＲＮＦＬ厚度有直线关系（Ｒ２ ＝０．１８６,ｔ＝４．７６,Ｐ＝０．００;Ｒ２＝０．１４６,ｔ＝２．６５,Ｐ＝０．０１）,ＲＮＦＬ厚度、ＭＳ与肿瘤体积均无直线关系（均为Ｐ＞０．０５）。结论　视野缺损类型与垂体腺瘤侵犯视交叉的位置有关。相应受累眼视野缺损程度与视网膜ＲＮＦＬ厚度、ＭＳ值有一致性。受累眼的ＭＳ值变化与ＲＮＦＬ厚度有一致性。视野缺损改变、ＲＮＦＬ厚度、ＭＳ与肿瘤体积单一因素无关。     

原发性青光眼合并早期垂体腺瘤的临床分析

目的:通过分析青光眼的中心视野、周边视野以及头颅影像学检查结果,诊断早期垂体腺瘤。方法:回顾分析7例原发性青光眼合并早期垂体腺瘤的临床资料。原发性青光眼中,2例为急性闭角型,1例为慢性闭角型,4例为开角型。患者均行中心及周边视野、头颅X射线平片、电子计算机X射线断层扫描(CT)或者核磁共振成像(MRI)检查。结果:除了青光眼性视野改变,所有患者均有颞上象限不同程度的视野缺损,进而做头颅影像学检查,发现了垂体腺瘤。结论:青光眼与垂体腺瘤均可有视野的损害,前者的改变早期位于中心,而后者可以位于周边。建议对青光眼患者的视野检查范围应包括中心及周边,如果周边视野有象限性缺损,须行头颅X射线平片、CT或者MRI检查,以防漏诊、误诊垂体腺瘤。     

应用Humphrey三区筛选法检查垂体大腺瘤患者的视野缺损

目的评价Humphrey三区筛选法检查垂体大腺瘤(pituitarymacroadenoma,PMA)患者视野缺损的临床价值.方法采用全自动Humphrey静态视野计的三区筛选法,对经MRI和CT确诊的128例PMA患者和门诊30例轻度近视患者,进行中心30°76个点视野检查.结果PMA组127例(99.2%)的患者有视野缺损,111例(86.7%)的患者以颞侧(包括单眼颞侧)视野缺损为主并且呈现或趋向中线垂直分界.其敏感性(相对检查例数的百分比)为99.2%,每眼视野平均检查时间(5.8±2.2)min,而采用全阈值方法检查中心30°76个点视野的平均检查时间为(14.8±2.8)min,两者比较差异有非常显著性(t=63.6396,P<     

垂体腺瘤对视功能损害的临床观察

目的：探讨垂体腺瘤对眼视功能损害的临床表现。方法：对126例（252只眼）垂体腺瘤患者进行视力、视野、荧光眼底血管造影（Fundusfluoresceinangiography，FFA）、图形视诱发电位（Patternvisualevokedpotential，PVEP）及眼底检查。结果：视力下降186只眼，占73．8％。眼底原发性视神经萎缩130只眼，占51．6％。视野缺损156只眼，占69．6％。PVEP异常160只眼，占88．9％。26．2％的患者以眼部异常为首诊症状．其中16．7％曾被诊断为眼科疾病。结论：垂体腺瘤可引起视功能的损害，充分认识垂体腺瘤在眼部的临床特点，有助于早期诊断及时治疗。     

垂体瘤患者眼部表现临床分析

目的:分析垂体瘤患者的眼部表现。方法:对180例360眼诊断明确的垂体瘤患者进行视力、双眼中心视野及眼底检查。结果:视力损害者236眼(65.6%),视野损害者296眼(82.2%),眼底改变者168眼(46.7%)。结论:垂体瘤可引起视功能损害,视野检查在垂体瘤患者的诊断中具有重要价值。     

Visual parameters in patients with pituitary adenoma before and after transsphenoidal surgery

Eighty-two patients with pituitary adenoma who underwent transsphenoidal surgery were examined before and after surgery. Nineteen patients had a normal preoperative neuro-ophthalmological examination. All of these patients maintained normal visual parameters postoperatively. The remaining 63 patients had tumour-related loss of visual acuity, visual field, or both. These patients ranged in age from 18 to 78 years. Duration of symptoms ranged from one day to ten years, with a median of six months. Preoperative visual acuity was 6/12 or better in 72% of eyes, with 90% of patients having 6/12 or better in their better eye. Only 7% of eyes had a normal preoperative visual field. Both visual acuity and visual field improved postoperatively in the majority of eyes. In eyes that were examined within one week after surgery and subsequently, substantial improvement occurred within the first postoperative week, but further improvement continued over weeks to months postoperatively, with visual field taking longer to stabilise than visual acuity. Visual acuity at last examination was 6/12 or better in 87% of eyes, and visual field at last examination was normal in 50% of eyes. A total of 92% of patients had visual acuity of 6/12 or better in their better eye, and 62% of patients had a normal visual field in their better eye. Visual acuity at last examination was correlated with both age and preoperative visual acuity. Last visual field also was correlated with both age and preoperative visual field. Patients with preoperative optic atrophy had a poorer visual prognosis than did patients with normal fundi.     

The role of optical coherence tomography in the detection of pituitary adenoma

Purpose: To analyse retinal nerve fibre layer (RNFL) thickness in eyes with compression of the optic chiasm by a pituitary adenoma. RNFL thickness was analysed with optical coherence tomography (OCT) and compared to visual field measurements using high‐pass resolution perimetry (HRP). Methods: Sixteen eyes from eight patients with pituitary adenoma were studied. All had bitemporal visual field depression caused by compression of the optic chiasm. Patients were submitted to an ophthalmic examination more than 14 months after surgery (seven patients had undergone trans‐sphenoidal and one trans‐cranial adenomectomy). The examination included HRP, fundus photography and measurement of the peripapillar RNFL thickness using OCT. Results: In spite of temporal visual field depression, not all eyes showed reduced RNFL thickness by OCT. This was also true for some eyes in which RNFL was judged to be reduced on fundus photographs. Contrary to our expectations, RNFL thickness in the nasal quadrant was normal in nine of the 16 eyes. Corresponding figures for the superior, inferior and temporal quadrants were eight, six and five, respectively. The overall RNFL thickness, as measured by OCT, did not correlate well with neural capacity, which is an index of remaining retino‐cortical neural channels in HRP. Conclusion: RNFL thickness as measured with OCT was reduced in most, but not all, eyes with temporal field depression caused by chiasmal compression. The pattern of RNFL loss did not correlate well with the visual field defect. Sensitivity of RNFL thickness measurement in OCT was low. The method has limited value in the diagnosis of pituitary tumour compression.     

Endocrinological associations of pituitary tumors

The patient presented with poor vision (particularly OS) which had declined progressively over ten years. He had had bifrontal headaches over the past two years. Examination and visual field testing showed optic atrophy and a bitemporal hemianopia. Procedures leading to the diagnosis of pituitary adenoma are discussed, as are treatment modalities and association of pituitary adenomas with other entities.     

Predictive factors of visual function recovery after pituitary adenoma resection: a literature review and Meta-analysis

AIM: To determine the dominant predictive factors of postoperative visual recovery for patients with pituitary adenoma. METHODS: PubMed, Google Scholar, Web of Science and Cochrane Library were searched for relevant human studies, which investigated the prediction of the postoperative visual recovery of patients with pituitary adenoma, from January 2000 to May 2017. Meta-analyses were performed on the primary outcomes. After the related data were extracted by two independent investigators, pooled weighted mean difference (WMD) and odds ratio (OR) with 95% confidence interval (CI) were estimated using a random-effects or a fixed-effects model. RESULTS: Nineteen studies were included in the literature review, and nine trials were included in the Meta-analysis, which comprised 530 patients (975 eyes) with pituitary adenoma. For the primary outcomes, there was a significant difference between preoperative and postoperative mean deviation (MD) values of the visual field (WMD -5.85; 95%CI: -8.19 to -3.51; P<0.00001). Predictive characteristics of four factors were revealed in this Meta-analysis by assigning the patients to sufficient and insufficient groups according to postoperative visual field improvements, including preoperative visual field defect (WMD 10.09; 95%CI: 6.17 to 14.02; P<0.00001), patient age (WMD -12.32; 95%CI: -18.42 to -6.22; P<0.0001), symptom duration (WMD -5.04; 95%CI: -9.71 to -0.37; P=0.03), and preoperative peripapillary retinal nerve fiber layer (pRNFL) thickness (OR 0.1; 95% CI: 0.04 to 0.23; P<0.00001). CONCLUSION: Preoperative visual field defect, symptom duration, patient age, and preoperative pRNFL thickness are the dominant predictive factors of the postoperative recovery of the visual field for patients with pituitary adenoma.     

Wegener's granulomatosis,pituitary adenoma and BARN

A 53-year-old man with Wegener's granulomatosis and a co-existing pituitary adenoma developed bilateral acute retinal necrosis (BARN), probably secondary to varicella-zoster virus (VZV) infection as IgM antibodies were detected in the serum. Intravenous acyclovir and ganciclovir limited the spread of necrosis, but to prevent recurrence he was maintained on oral acyclovir. A left cataract developed 17 months later which was extracted and replaced with a heparin surface modified intraocular lens. Intraocular specimens removed at the time of surgery were analysed by the polymerase chain reaction (PCR) using primers specific for a number of the herpes group of viruses, but no herpesviral DNA could be detected.     

眼科检查和功能性磁共振在垂体腺瘤研究中的应用进展

垂体腺瘤是颅内最常见的良性肿瘤,其症状主要为视功能受损和内分泌激素紊乱。由于垂体与视交叉的特殊位置关系,视力下降和视野缺损多为首发症状,患者常常首诊于眼科。视野检查和光学相干断层扫描(OCT)可判断视野缺损程度和眼底情况,电生理检查可明确视神经是否受损,均可作为垂体腺瘤患者视功能的评估指标。磁共振作为影像学工具,其衍生技术——功能性磁共振,近年来用于研究垂体腺瘤瘤体质地及视神经完整性。此类全面详细的检查可以帮助患者明确最佳治疗时机,提高生活质量。本文针对眼科各项检查(视野、OCT和电生理)和功能性磁共振在垂体腺瘤中的应用进行简要综述。