垂体瘤169例患者视野分析

目的 比较垂体瘤患者术前中心静态视野与周边动态视野,探讨术前视野缺损的危险因素和术后视野改善的影响因素.方法 回顾性系列病例研究.2006年2月至2007年2月确诊为垂体瘤的患者169例(338只眼),于术前行视力、眼底、视野及影像学检查.其中,334只眼行周边动态视野检查;323只眼行中心静态视野检查.28例(56只眼),于术后3～6个月进行视力、中心静态视野及周边视野随访.连续变量符合参数检验的采用t检验,非参数检验采用秩和检验;分类变量采用卡方检验或Fisher精确检验.对影响因素行Logistic回归分析.结果 169例患者中,36例双眼视野正常,133例单眼或双眼视野缺损;323只眼行中心静态视野检查,视野正常眼占28.48%(92/323),视野缺损眼占71.52%(231/323);334只眼行周边视野检查,视野正常眼占41.32%(138/334),视野缺损眼占58.68%(196/334);视野正常组与缺损组,起病年龄和垂体瘤直径及术前最佳矫正视力间差异有统计学意义(t=4.802、7.930;x~2=28.210,P＜0.01),经多因素分析,其均为术前视野缺损的影响因素.垂体瘤摘除术后,患眼最佳矫正视力恢复正常或改善占69.05%(29/42),视野恢复正常或改善占85.71%(36/42);视野恢复正常组与改善组,起病年龄和术前颞上方视野缺损情况两组间差异有统计学意义(t=2.525,P=0.023;x~2=6.218,P=0.013).结论 中心静态视野检查较周边视野检查敏感,可发现垂体瘤患者的早期视野改变.起病年龄、肿瘤直径以及最佳矫正视力是术前视野缺损的危险因素.起病年龄与术前颞上方视野缺损程度在术后视野恢复正常组与改善组存在统计学差异.

Visual field defects in 169 cases of pituitary adenomas

Objective To compare static visual field perimetry with Octopus101 and Goldmann perimetry in patients with pituitary adenomas;To identify the factors of visual field defects and visual field prognosis.Methods Retrospective nested case-control study.Visual acuity,fundus,computed tomography (CT) or magnetic resonance imaging (MRI) and visual field were pre-operated assessed in 169 patients (338 eyes) diagnosed pituitary adenoma at the Department of Neurosurgery in Huashan Hospital between Feb.2006 and Feb.2007.334 eyes were underwent Goldmann perimetry,while 323 eyes were underwent static visual field perimetry with Octopus101 perimeter.In the169 patients,28 patients (56 eyes) were followed up post-operatively for 3 to 6 months.Statistical analysis was performed using SPSS 15.0 software.T test and rank sum test were used for continuous variables,and chi-square test and Fisher's exact test were used for categorical variables.We also carry out Logistic regression.Results Of the 169 patients,unilateral or bilateral visual field defects were observed in 133 cases.In these 323 eyes,231 eyes showed visual field defects with static visual field perimetry,while 196 eyes in 334 eyes showed defects with Goldmann perimetry.Earlier age of onset,larger tumors and poor preoperative corrected visual acuity were more frequent in patients with visual field defects than in patients with normal visual fields (t=4.802,7.930;x~2=28.210,P＜0.01).In the 28 followed-up patients (55 eyes),visual acuity was improved in 69.05% eyes and visual field was improved in 85.71% eyes after operation.There were significant differences in age of onset and preoperative visual field defects in upper temporal quadrants between patients with visual field returned to normal after the operation and patients with visual field improvement only (t=2.525,P=0.023;x~2=6.218,P=0.013).Conclusions Static visual field perimetry with Octopus101 perimeter is more sensitive than Goldmann perimetry in the early diagnosis of pituitary adenornas.Patients with visual field abnormalities are significantly with earlier onset age,larger tumors and worse preoperative visual acuity than patients free of visual field defects.The onset age and the degree of impairment in the preoperative visual field in the upper temporal quadrant may be significant factors for visual field prognosis.