LAUSR

PURPOSE To investigate the association between optical coherence tomography (OCT) parameters and long-term visual recovery following optic chiasm decompression surgery. DESIGN Prospective cohort study. METHODS Consecutive patients undergoing pituitary or parasellar tumor resection, between January 2009 to December 2018, were recruited in a single-centre, two-year prospective, longitudinal cohort study. Best-corrected visual acuity, visual fields, and OCT retinal nerve fibre layer (RNFL) thickness, macular thickness and volume were assessed pre-operatively, and at 6 weeks, 6 months, and 2 years post-operatively. Long-term visual field recovery and maintenance was defined as a mean deviation greater than -3 at 24 months, and visual acuity recovery and maintenance was defined as a logMAR of 0 (Snellen 20/20) or better at 24 months. RESULTS Two hundred and thirty-nine patients (129 males, 110 females; mean±SD age, 52±16 years) were included. Multiple logistic regression analysis demonstrated that increased inferior RNFL thickness (per 10μm) was associated with higher odds of long-term visual field recovery and maintenance (OR=1.26; 95% CI, 1.12-1.41; Q<0.001), and greater superior RNFL thickness (per 10μm) was associated with higher odds of visual acuity recovery and maintenance (OR=1.13; 95% CI, 1.03-1.27; Q=0.031). A multivariable risk prediction model developed for long-term visual field recovery and maintenance, incorporating age, pre-operative visual function and RNFL thickness, demonstrated C-statistics of 0.83 (95% CI, 0.72-0.94). CONCLUSIONS Pre-operative RNFL thickness was associated with long-term visual recovery and maintenance following chiasmal decompression. The multivariable risk prediction model developed in the current study may assist with pre-operative patient counselling and prognostication.