Objective:

To identify endocrine and radiological tumor characteristics associated with higher risk of visual impairment.

Approach:

• Study Design: A retrospective observational study including 40 patients with pituitary macroadenoma.
• Variables Analyzed: Age, sex, disease duration, treatment, hormonal profile, tumor volume, visual acuity, perimetry, and retinal analysis using optical coherence tomography (OCT).

Key Findings:

• Surgery normalized ACTH, cortisol, IGF-1, and prolactin levels.
• Larger tumor volumes were associated with worse visual field, while visual acuity remained stable.
• OCT showed thinning of total retina and inner retinal layers in patients with disease duration >5 years, nonfunctioning tumors, larger tumors, postoperative status, and relapse (p < 0.05).
• Macular ganglion cell layer thickness correlated inversely with IGF-1 and prolactin, while retinal nerve fiber layer thickness correlated with tumor size.
• The inner nuclear layer exhibited non-linear behavior, thickening in early stages and thinning in severe injury.

Interpretation:

Hormonal and radiological factors are associated with visual dysfunction. OCT and perimetry detect early visual pathway damage better than visual acuity.

Limitations:

• Retrospective design may limit causal inferences.
• Exclusion of patients with certain ocular or neurological conditions may affect generalizability.

Conclusion:

Non-linear behavior of the inner nuclear layer stands out as a potential prognostic biomarker.