Prognostic value of optical coherence tomography parameters in assessing the anterior visual pathway in patients with suprasellar meningiomas

BACKGROUND: Compression suprasellar meningioma compresses the structures of the anterior visual pathway, which leads to retrograde degeneration of optic nerve fibers. It manifests as decreased visual functions and primary descending optic atrophy. Optical coherence tomography assesses the retinal ganglion cell complex and peripapillary retinal nerve fiber layer in vivo and measures their thickness. Structural changes in the anterior visual pathway manifest as thinning of the ganglion cell layer and peripapillary retinal nerve fiber layer.

AIM: The study aimed to determine the prognostic factors for changes in visual function after surgical management of suprasellar meningioma using optical coherence tomography.

METHODS: The study included data from 44 patients (9 men and 35 women) aged 28–72 years with suprasellar meningioma who underwent surgery at the Neurosurgery Center from 2023 to 2024. The median age was 51 years. A total of 16 healthy volunteers were included in the control group to determine reference values of optical coherence tomography parameters. All patients underwent standard ophthalmological examination and optical coherence tomography to measure thickness of the ganglion cell layer in 6 sectors and the peripapillary retinal nerve fiber layer in 4 sectors. Сatamnesis from 3 to 17 months was analyzed in 20 patients.

RESULTS: In the early postoperative period, out of 70 cases, visual function fully recovered, improved, and remained unchanged in 14 (20%), 42 (60%), and 14 (20%) cases, respectively. A positive correlation was revealed between preoperative morphometric retinal parameters and visual function both before and after surgery (p < 0.001). The correlation is stronger in the postoperative period which allows using optical coherence tomography parameters for prognosis. Thickness of the peripapillary retinal nerve fiber layer in the temporal and superior sectors was found to be the most significant predictor of improvement of visual function in the early postoperative period. ROC analysis determined threshold thickness of the retinal nerve fiber layer for visual function to be fully restored both in the early and long-term postoperative period.

CONCLUSION: Morphometric retinal parameters determine the visual impairment stage. They help predict the degree of postoperative recovery of visual function. In the early postoperative period, visual function recovers fully in the eyes with more intact peripapillary retinal nerve fiber layers in the superior and temporal quadrants (RNFL_S ≥ 104 µm; RNFL_T ≥ 53 µm); recovery of visual function in the long-term postoperative period is determined by the parameters of retinal ganglion cells (GCL_I ≥ 59 µm; GCL_IN ≥ 58 µm; GCL_SN ≥ 59 µm).