Blindness following pituitary apoplexy: Timing of surgery and neuro-ophthalmic outcome

The aim of this study is to report the neuro-ophthalmic outcome in patients who underwent transsphenoidal decompression for unilateral or bilateral blindness that was due to pituitary apoplexy. Four patients who were rendered blind (with an absence of light perception) unilaterally or bilaterally as a result of pituitary apoplexy were studied. Neuro-ophthalmic evaluation was performed pre- and post-operatively. Patients underwent CT and MRI pre-operatively and CT post-operatively. All four patients underwent transethmoidal decompression of the pituitary adenoma. One patient underwent a second transcranial procedure to remove the remaining suprasellar component of the tumor. Visual acuity, visual fields and extra-ocular movements were documented during the follow-up period. There were three males and one female. Ages ranged from 40 to 68 years. Three patients had unilateral blindness and, one was blind in both eyes. Two of the four patients had associated ophthalmoplegia. All the four patients presented within one week of ictus. One patient underwent surgery within the first week, two patients underwent surgery two and three weeks after ictus and the, other patient underwent surgery two months after ictus. The patient who was operated on within the first week recovered from bilateral blindness to a visual acuity of 6/9 and 6/12 with superior quadrantic field defects. The two patients who were operated on two and three weeks after ictus improved to 6/60 in the affected eyes and the patient who was operated on after two months improved to 1/60 in the affected eye. Both the patients with ophthalmoplegia improved completely even though the surgery was delayed by two months for one patient. Although blindness following pituitary apoplexy is rare, visual acuity improves in most patients following transsphenoidal surgery. Early surgery within the first week after ictus leads to excellent visual outcome when compared with surgery that is performed at a later stage. In contrast to visual outcome, ophthalmoplegia, improves even if surgical decompression is delayed. (c) 2007 Elsevier Ltd. All rights reserved.