The aim of this study is to report the neuro-ophthalmic outcome in patients who underwent transsphenoidal
decompression for unilateral or
bilateral blindness that was due to
pituitary apoplexy. Four patients who were rendered blind (with an absence of light perception) unilaterally or bilaterally as a result of
pituitary apoplexy were studied. Neuro-ophthalmic evaluation was performed pre- and post-operatively. Patients underwent CT and MRI pre-operatively and CT post-operatively. All four patients underwent transethmoidal
decompression of the
pituitary adenoma. One patient underwent a second transcranial procedure to remove the remaining suprasellar component of the
tumor. Visual acuity, visual fields and extra-ocular movements were documented during the follow-up period. There were three males and one female. Ages ranged from 40 to 68 years. Three patients had
unilateral blindness and one was blind in both eyes. Two of the four patients had associated
ophthalmoplegia. All the four patients presented within one week of ictus. One patient underwent surgery within the first week, two patients underwent surgery two and three weeks after ictus and the other patient underwent surgery two months after ictus. The patient who was operated on within the first week recovered from
bilateral blindness to a visual acuity of 6/9 and 6/12 with superior quadrantic field defects. The two patients who were operated on two and three weeks after ictus improved to 6/60 in the affected eyes and the patient who was operated on after two months improved to 1/60 in the affected eye. Both the patients with
ophthalmoplegia improved completely even though the surgery was delayed by two months for one patient. Although
blindness following
pituitary apoplexy is rare, visual acuity improves in most patients following transsphenoidal surgery. Early surgery within the first week after ictus leads to excellent visual outcome when compared with surgery that is performed at a later stage. In contrast to visual outcome,
ophthalmoplegia improves even if
surgical decompression is delayed.