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Prog Retin Eye Res. 2019 Nov;73:100765. doi: 10.1016/j.preteyeres.2019.06.001. Epub 2019 Jun 14.

Visual loss and recovery in chiasmal compression.

Author information

1
Department of Ophthalmology, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. Electronic address: helendm@gmail.com.
2
Department of Ophthalmology, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
3
Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, University of Sydney, NSW, Australia.
4
Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, USA.

Abstract

Compression of the optic chiasm causes an optic neuropathy that may be associated with reversible visual loss often immediately following surgical decompression. While the precise pathogenesis of retinal ganglion cell impairment and eventual death remains poorly understood, a number of putative mechanisms may play a role. In this article we review the evidence supporting various stages of visual loss and recovery in chiasmal compression. These include conduction block, demyelination, ischemic insult, and retrograde and anterograde degeneration. We also describe novel advances in magnetic resonance imaging with specialized modalities such as diffusion tensor imaging have provided further information to explain the underlying mechanism of visual loss. Functional measures including electrophysiology are time-consuming but have shown moderate prognostic ability. Optical coherence tomography has provided novel new biomarkers for predicting outcome following surgical decompression. Both retinal nerve fiber layer thickness and ganglion cell complex thicknesses have shown to have excellent predictive power. Such advances serve to inform patients and clinicians of pre-operative factors that predict the extent of visual recovery following medical or surgical treatment of para-chiasmal lesions.

KEYWORDS:

Axonal injury; Meningioma; Optic chiasm; Optic nerve compression; Optical coherence tomography; Pituitary adenoma; Retinal ganglion cells; Visual pathways; Visual prognosis

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