Glaucoma-Like Optic Neuropathy in Patients with Intracranial Tumors

Jost Jonas

Purpose: To examine frequency and associated factors of a glaucoma-like appearance of the optic nerve head in patients with intrasellar, suprasellar or parasellar tumors.

Methods: The study included patients who were consectutively treated for intrasellar tumors (n=143), suprasellar tumors (n=321), parasellar tumors (n=36), or retrosellar tumor (n=1), and all of whom had undergone fundus photography and full-threshold visual field examination. The tumor spectrum included 336 pituitary gland tumors, 32 meningeomas, 89 craniopharyngiomas, 9 chiasmal gliomas, and 35 other types of tumors or lesions. An age-matched control group was formed from the population-based Beijing Eye Study. Using the fundus photographs and visual field examinations, glaucoma was defined by a neuroretinal rim shape not following the ISNT rule (Disc-Glaucoma group), and by an abnormal rim shape plus glaucoma-like visual field defects (Field-Glaucoma Group). Type and size of the tumors were assessed on neuroradiological images.

Results: Five-hundred and one patients fulfilled the inclusion criteria. Disc-Glaucoma and Field Glaucoma were detected significantly more frequently in the study population (34 (6.8±1.1%) patients and 31 (6.3±1.1%) patients, respectively) than in the population-based control group of the same ethnicity (1.3% ± 0.5% (0.3%-2.3%); P<0.001). In multivariate analysis, presence of Disc-Glaucoma and Field-Glaucoma was significantly associated with tumor location (suprasellar > parasellar > intrasellar (OR=2.64; P=0.016; and OR=3.01; P=0.027, resp.)) and tumor width (OR=1.08; P=0.002; and OR=1.08; P=0.003, resp.).

Conclusions: Large perisellar tumors were associated with a glaucoma-like appearance of the optic nerve head in eyes. It may diagnostically and pathogenetically be of importance.