Abstract

Background Pituitary apoplexy is often treated urgently, but this is based on studies which assess vision categorically and dichotomizes the time interval between symptom onset and surgery which may introduce bias in measuring an association between the two.

Objective This study was aimed to assess for a relationship between continuously valued surgery delay and visual acuity recovery after pituitary apoplexy.

Methods In this retrospective study, all patients presenting with symptomatic pituitary apoplexy between 2004 and 2016 were identified from an institutional database. The primary endpoint was visual acuity improvement, measured as the difference in acuity from the pre- to postoperative period, and measured in Logarithm of the Minimal Angle of Resolution (LogMAR) units. Analysis was performed using continuous values of time delay and visual acuity to assess for an underlying association.

Results Thirty-two pituitary apoplexy patients were identified. Visual acuity deficits were reported in 81%. The median visual acuity was 0.35 LogMAR (Snellen's fraction 20/40) preoperatively, and 0.1 (20/25) postoperatively (p < 0.01). The time between symptom onset and surgery was not associated with improvement in visual acuity (p = 0.46). When the time delay and visual outcome were intentionally dichotomized, patients undergoing surgery within 2 days of symptom onset had 0.21 times the odds of a good visual outcome (95% confidence interval [CI]: 0.04–1.05).

Conclusion When assessed as continuously valued measures, the time from symptom onset to surgical intervention and the improvement in visual acuity are not associated, although intentional dichotomization of data produced conflicting results.

Disclosure

The authors have no conflicts of interest to disclose. One author (P.D.K.) is supported by a training grant from the National Cancer Institute of the National Institutes of Health under award number T32CA106183. There are no drugs, materials, or devices described in this submission.

中文翻译：

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垂体卒中手术时机对持续评价视力的影响

摘要

背景 垂体卒中通常需要紧急治疗，但这是基于对视力进行分类评估并将症状发作和手术之间的时间间隔分开的研究，这可能会在测量两者之间的关联时产生偏差。

目的 本研究旨在评估垂体卒中后持续评估手术延迟与视力恢复之间的关系。

方法 在这项回顾性研究中，从机构数据库中确定了 2004 年至 2016 年期间出现症状性垂体卒中的所有患者。主要终点是视力改善，测量为从术前到术后期间的视力差异，并以最小分辨率角 (LogMAR) 单位的对数测量。使用时间延迟和视力的连续值进行分析，以评估潜在的关联。

结果 确定了32例垂体卒中患者。81% 的人报告了视力缺陷。术前中位视力为 0.35 LogMAR（Snellen 分数 20/40），术后为 0.1（20/25）（p  < 0.01）。症状出现和手术之间的时间与视力改善无关（p  = 0.46）。当故意将时间延迟和视力结果二分法时，在症状出现后 2 天内接受手术的患者获得良好视力结果的几率是 0.21 倍（95% 置信区间 [CI]：0.04-1.05）。

结论 当评估为连续价值测量时，从症状出现到手术干预的时间与视力的改善不相关，尽管有意对数据进行二分法产生了相互矛盾的结果。

披露

作者没有利益冲突要披露。一位作者 (PDK) 得到了美国国立卫生研究院国家癌症研究所的培训资助，奖励编号为 T32CA106183。此提交中没有描述药物、材料或设备。