Conservative management of pituitary macroadenoma contacting the optic apparatus

Objectives: To describe the tumor characteristics and visual function in conservatively managed patients with non-functioning pituitary macroadenoma (NFMA) that contacted/compressed the visual pathway. Design: Retrospective case-series. Setting: Tertiary-care academic institution. Participants: Six patients with diagnosis of NFMA. Main Outcome: Visual function and radiological characteristics of the optic apparatus and pituitary tumor. Results: All patients had radiological evidence of optic apparatus compression but only one had visual field defect at the initial presentation. While two of the six patients developed visual field changes during followup (41±34.8 months), the patient with visual field defect at the time of diagnosis improved to normal vision. Conclusions: Select NFMAs that contact the optic apparatus, without visual dysfunction, may be managed with close ophthalmological and radiographic monitoring, depending on tumor and imaging characteristics. This may be of particular relevance in patients considered to have a high peri-operative risk, such as advanced age or significant co-morbidities.