Visual Acuity, Perimetric and Optic Disc Findings at Presentation in Pituitary Macroadenoma: A Retrospective Indonesian Series

Abstract

Background: Pituitary macroadenoma compresses the optic chiasm, and the resulting visual loss becomes irreversible once retinal ganglion cells die. No Indonesian series describes their visual status at first specialist contact.

Methods: Retrospective review of consecutive pituitary macroadenoma patients at a West Sumatran referral hospital, July 2022 to October 2025, reported per STROBE. Proportions carry 95% Wilson intervals, tested against published benchmarks with Holm adjustment. Because the records give marginal rather than patient-level data, unidentified associations were bounded by enumerating every contingency table consistent with the observed margins.

Results: Seventeen of 18 patients were eligible (34 eyes); 11 (64.7%) were female and 11 (64.7%) aged 21–40 years, neither differing detectably from an even split (p = 0.332). Under every admissible eye pairing at least 13 of 17 (76.5%) had an eye below 6/18 versus a 25% benchmark (p < 0.001, h = +1.082). All 17 had an abnormal field versus a 70% benchmark (p = 0.003, h = +1.159): bitemporal hemianopia in 10 (58.8%), generalised depression in 7 (41.2%). Optic atrophy affected 9 (52.9%), papilloedema none. All seven with generalised depression had optic atrophy, versus 2 of 10 with bitemporal hemianopia (risk difference +80.0 pp, 95% CI +32.9 to +94.3; p = 0.002). Four of 17 tests survived Holm adjustment; others were unidentified, their odds ratio bounds spanning the null.

Conclusion: This cohort presented with markedly advanced visual compromise, optic atrophy being established in over half, without detectable demographic difference from international series. Unexplained visual complaints warrant early perimetry and fundoscopy.