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Use of optical coherence tomography in predicting post-treatment visual outcome in anterior visual pathway meningiomas
  1. Jing-Liang Loo1,2,
  2. Jing Tian3,
  3. Neil R Miller1,
  4. Prem S Subramanian1,4
  1. 1Neuro-Ophthalmology Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Singapore National Eye Centre, 11 Third Hospital Ave, Singapore 168751
  3. 3Biostatistics Core, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  4. 4Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda MD 20814
  1. Correspondence to Dr Prem S Subramanian, Department of Ophthalmology, Wilmer Eye Institute, Woods 457, 600 N Wolfe St, Baltimore MD 21287, USA; psubram1{at}jhmi.edu

Abstract

Purpose To determine the prognostic value of pretreatment optical coherence tomography (OCT) measurement of the peripapillary retinal nerve fibre layer (PRNFL) in final visual outcomes of patients with anterior visual pathway meningioma and optic neuropathy.

Methods Retrospective case series from a tertiary care academic referral centre. Fourteen eyes (12 patients) in which pretreatment and post-treatment OCT, visual field and comprehensive neuro-ophthalmic exam data were available were evaluated for visual acuity, colour vision and visual field change after neurosurgical and/or radiation oncologic treatment.

Results Twelve patients and 14 eyes were analysed. Patients had tumours centred at the tuberculum sella (3), planum sphenoidale (3), anterior clinoid (2), optic nerve sheath (2), sphenoid wing (2) and olfactory groove (1). Nine eyes had normal PRNFL thickness (mean 95.5 μm± 11.0), whereas five eyes had thin PRNFL (mean 66.0 μm ± 14.2). The mean duration of follow-up was 9.7 months. There was no significant difference in age, duration of symptoms or duration of follow-up between both groups (p=0.22). After treatment, the normal PRNFL group experienced significant improvement in the visual acuity (p=0.03), colour vision (p=0.016), perimetric mean deviation (p=0.019) and foveal threshold (p=0.016) but not pattern SD (p=0.074) compared with the group with thin PRNFL. On multivariate analysis, duration of symptoms, but neither age nor follow-up duration, predicted final visual outcome.

Conclusions Patients with compressive optic neuropathy due to anterior pathway meningiomas are more likely to improve post-treatment if they have a normal pretreatment PRNFL and shorter duration of symptoms.

  • Optic Nerve
  • Visual Pathway
  • Field of Vision
  • Diagnostic Tests/Investigation

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