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Issue

Vol 135 No 1559: 5 August 2022

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Issue Summary

Clinical Correspondence
SUMMARY

Visual recovery following surgical intervention for pituitary apoplexy correlated with preoperative optical coherence tomography

This is a case report of a 52-year-old female who was referred by her optometrist to the acute eye clinic with three weeks of headache and progressive peripheral visual field loss in a distinctive pattern (as seen on testing with a visual field testing machine). An MRI scan (Magnetic Resonance Imaging – a type of cross-sectional scan providing clear images of the structures of the brain) revealed bleeding at the pituitary gland (a structure in the brain that plays in important role in hormonal regulation) which was causing compression of the optic nerves (the nerves connecting the retinas of the eye to the visual cortex of the brain) at the optic chiasm (a region in the brain near the pituitary gland, where part of each optic nerve crosses over to the opposite hemisphere of the brain). The patient had removal of the pituitary bleed by the neurosurgical team and careful replacement of hormonal deficiencies by the endocrinology team. Optical coherence tomography scans (specialised cross-sectional scans of the different layers of the retina) were performed before the patient proceeded to surgery and suggested damage to the optic nerves particularly in the left eye. The final visual field tests showed an essentially complete recovery in the right eye and a small persistent visual field defect in the left eye, which likely correlated to the greater damage to the left optic nerve suggested by the preoperative OCT scan.

Clinical Correspondence
SUMMARY

Visual recovery following surgical intervention for pituitary apoplexy correlated with preoperative optical coherence tomography

This is a case report of a 52-year-old female who was referred by her optometrist to the acute eye clinic with three weeks of headache and progressive peripheral visual field loss in a distinctive pattern (as seen on testing with a visual field testing machine). An MRI scan (Magnetic Resonance Imaging – a type of cross-sectional scan providing clear images of the structures of the brain) revealed bleeding at the pituitary gland (a structure in the brain that plays in important role in hormonal regulation) which was causing compression of the optic nerves (the nerves connecting the retinas of the eye to the visual cortex of the brain) at the optic chiasm (a region in the brain near the pituitary gland, where part of each optic nerve crosses over to the opposite hemisphere of the brain). The patient had removal of the pituitary bleed by the neurosurgical team and careful replacement of hormonal deficiencies by the endocrinology team. Optical coherence tomography scans (specialised cross-sectional scans of the different layers of the retina) were performed before the patient proceeded to surgery and suggested damage to the optic nerves particularly in the left eye. The final visual field tests showed an essentially complete recovery in the right eye and a small persistent visual field defect in the left eye, which likely correlated to the greater damage to the left optic nerve suggested by the preoperative OCT scan.

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