Role of Optical Coherence Tomography in Predicting Visual Outcome after Surgery for Sellar and Supra-Sellar Tumors

Background: Almost one-fifth of patients undergoing surgery for sellar/supra-sellar tumors do not gain a significant improvement in their vision. Various methods have been described to predict prospective visual outcomes in them, although they lack uniformity. Objective: The study was conducted to predict visual outcomes following surgery for sellar and supra-sellar tumors compressing the anterior optic pathway based on pre-operative optical coherence tomography (OCT) parameters. Methods and Materials: This was a record-based observational descriptive longitudinal study done in a tertiary care center in India. Thirty-seven patients (74 eyes) diagnosed with sellar supra-sellar lesions were included in the study. Patients' ophthalmic evaluations, done pre-operatively and 3 months post-operatively, were reviewed. Spectral-domain OCT and segmentation were done using the automated segmentation technology of Spectralis software. The thickness of the respective layers was measured. Results and Conclusions: The mean age of the study population was 42.68 years. Eyes with a pre-operative visual acuity component of VIS (visual impairment score) <= 61, pre-operative ganglion cell layer thickness >= 26.31 um, a pre-operative inner plexiform layer thickness of >= 25.69 um, a pre-operative ganglion cell inner plexiform layer thickness of 52.00 um, pre-operative ganglion cell complex thickness >= 84.47 mu m, and a pre-operative inner retinal layer thickness of >= 205.25 mu m were more likely to have an improved visual outcome. Eyes with a pre-operative duration of visual symptoms of >= 15 months, VIS >= 126.50, a pre-operative decimal visual acuity of <0.035, a pre-operative visual field index of <= 8%, a pre-operative macular thickness of <= 287.06 um, a pre-operative macular RNFL (retinal nerve fiber layer) thickness <= 66.00 mu m, and a pre-operative peri-papillary RNFL thickness <= 64.62 mu m were unlikely to have visual improvement.