Atlas of Ophthalmology

Pseudoglaucoma in Pituitary Adenoma (Colour Photography Posterior Pole, OCT, Visual Field, MRI)

العصب البصري -> إعتلال العصب البصري
Patient: 58 years of age, male, BCVA 1.0 at OD , 1.0 at OS, IOP 10/10 mmHg. General Medical History: in 2019 transsphenoidal resection of pituitary adenoma . Ocular Medical History: over 10 years unclear visual field defect at OD and OS, progression of retinal nerve layer thickness. Main Complaint: visual field defects. Purpose: to present pseudo-glaucomatous optic nerve head in pituitary adenoma. Methods: colour photography posterior pole, OCT, visual field, MRI. Findings: Colour Photography Posterior Pole: optic nerve head area, 3,0 mm² at OD, 2.8 mm² at OS, circular thinning of rim at OD & OS. Visual Field: at OD, circumscript visual field defect temporal superior and temporal inferior; at OS, small defect superior. OCT-retinal nerve fiber thickness: at OD complete temporal thinning of retinal fiber layer, at OS, focal thinning of retinal fiber layer at 1h. OCT-retinal nerve fiber thickness progression over 10 years: at OD, -0.8µm per year; at OS, -1,4 µm per year. MRI: pituitary adenoma. Discussion: Kobayashi et al. (1) evaluated the medical records of 50 cases of pituitary tumor found in glaucoma patients. The glaucoma was unilateral in 19% and bilateral in 31%. The visual field defects corresponded with typical unilateral glaucoma in 23%, and with typical bilateral glaucoma in 77%. Glebauskiene et al. (2) evaluated retinal nerve fibre layer (RNFL) thickness in patients with pituitary adenoma (PA) in 154 eyes of 77 patients. RNFL thickness around the optic nerve disc was reduced significantly in all four quadrants. In PA patients with suprasellar extension RNFL thickness was reduced significantly only in the temporal quadrant. The chiasmal right side, middle part, left side heights correlated significantly with RNFL thickness in all quadrants. Special attention must be paid to glaucoma patients who complain of headaches. Literature: (1) Kobayashi N, Ikeda H, Kobayashi K, Onoda T, Adachi-Usami E. Characteristics of Fifty Cases of Pituitary Tumors in Eyes Diagnosed with Glaucoma.Nippon Ganka Gakkai Zasshi. 2016 Feb;120(2):101-9. (2) Glebauskiene B, Liutkeviciene R, Zlatkute E, Kriauciuniene L, Zaliuniene D. Association of retinal nerve fibre layer thickness with quantitative magnetic resonance imaging data of the optic chiasm in pituitary adenoma patients. J Clin Neurosci. 2018 Apr;50:1-6

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