Neuro-Ophthalmology

Case 2

Patient Presentation: A 44-year-old man noticed blurred vision in his left eye for one week. He was seen in the ophthalmology clinic and had a visual acuity of 20/20 OD and 20/30 OS. Dilated fundus examination was normal and an OCT RNFL and GCA were performed below.

Neuro-Ophthalmology 2-1.png
Neuro-Ophthalmology 2-2.png

Question: What visual field defect do you expect this patient to show?

Neuro-Ophthalmology 2-3.png
Neuro-Ophthalmology 2-4.png

Question: A Humphrey 24-2 visual field test was conducted following the RNFL and GCC OCT images. The results of the visual field test is shown above. Where do the patient’s OCT and visual field changes localize?

Neuro-Ophthalmology 2-5.png

Question: An MRI was performed (above) and showed a sellar/suprsellar lesion consistent with a pituitary macroadenoma - yellow arrows (optic nerves on the left image and optic chiasm on the right). What do you expect to happen after this patient has surgical resection of the pituitary macroadenoma?

At the 6-month follow-up, the following GCC-OCT and corresponding visual field tests were conducted. Of note, you can appreciate the persistent binasal ganglion cell complex loss despite improvement of the bitemporal homonymous hemianopia. Notice how this patient has a persistent supero-temporal visual field defect in the left eye and this corresponds to the denser pre-operative OCT-GCC thinning in the infero-nasal region.

Neuro-Ophthalmology 2-6.png
Neuro-Ophthalmology 2-7.png

Learning Objectives:

1. Analyzing GCC-OCT for detecting hallmark signs of chiasmal compression

2. Correlating OCT images to standard automated perimetry visual fields.