A one year cross sectional study of ocular manifestations of intracranial space occupying lesions in patients at kle’s dr. Prabhakar kore hospital and mrc, belagavi

Abstract

Background and objectives To evaluate ocular manifestations and visual field changes in patients with intra cranial space occupying lesions. A spectrum of visual manifestations has been reported with these tumors, ranging from the presence of any visual symptoms to severe visual field defects and loss of vision. The most common visual field defect is bitemporal hemianopia. However, other types of visual field defects may also be observed. The current study was undertaken to study the ocular manifestations in patients with intra cranial space occupying lesions at a single institute over a one-year period. Ocular manifestations include blurring of vision, visual field defects, loss of colour vision, optic disc atrophy or papilloedema. Knowledge of the more common tumors will assist the ophthalmologist in advising patients on plan of surgery, and deciding which patients should be followed and which require referral neurosurgeons or radiation oncologists. Methodology The present one year cross sectional study was conducted in the Department of Ophthalmology, KLES Dr. Prabhakar Kore hospital and Medical Research Centre, Belagavi on patients undergoing cataract surgery during the period of 1st January 2014-31st December 2014. The study was approved by the Ethical and Research Committee of Jawaharlal Nehru Medical College, Belagavi. Fifty patients with intra cranial space occupying lesions underwent a complete ophthalmic assessment and visual field analysis using the Humphrey Field Analyzer 30-2 program. Visual acuity, duration of symptoms, optic nerve head changes, pattern of visual field defects were noted. Results In present study, 50 patients with intracranial space occupying lesions are evaluated. The patient with least age in the present study was of 15yrs and the patient with maximum age was 66 yrs. The mean age of patients is 45. 90% of cases constitutes from age between 20 to 60. Male is to female ratio is 3:2. Diminution of vision (90%) was most common ocular presenting symptom. Headache was the most common systemic presenting symptom (70%) followed by seizures (2%). Maximum number of patients presented with more than one symptom. 66% of patients had the vision from 6/6-6/12, 10% patients were between 6/18-6/36 most of which presented with diminution of vision, 4% patients had vision less than 1 meter and 6% had no perception of light due to optic atrophy. Optic atrophy was the most common sign in the present study (20%). VIth cranial nerve palsy (10%) was most commonly found in the patients of present study followed by VIIIth cranial nerve palsy (04%) and III and IV cranial nerve palsy(04%). Papilloedema was found in 9 patients. Perimetry of 13 patients showed bitemporal hemianopia and 3 patient showed homonymous hemianopia. Constriction of peripheral field were present in 7 cases and 2 cases were found to be with arcuate scotoma. Most number of intracranial lesion were found peri-chismatic area (56%). 2nd most common site was found to be temporal lobe tumours (10%) followed by cerebello-pontine angle (6%). Automated perimetry of 6 cases did not show any visual field defects. Perimetry of 5 patients could not be done due to decreased visual acuity. In the present study the most commonly found type of tumour were the meningiomas (38%). 2nd most common site was found to be Pituitary Macroadenomas (32%),which were followed by Craniopharyngiomas(16%). Conclusion and interpretation If symptoms of patients of intracranial space occupying lesions are evaluated properly a detailed examination and investigations are done properly, these conditions can be diagnosed earlier. Thus prognosis is much improved as the patients gets proper treatment at an early stage. Inspite of advances made in the field of diagnostic investigations for intracranial tumours, the ophthalmologist continues to play a essential role in early detection, diagnosis and prognosis of these tumours as is indicated by a great number of ocular manifestations in our study. Background and objectives To evaluate ocular manifestations and visual field changes in patients with intra cranial space occupying lesions. A spectrum of visual manifestations has been reported with these tumors, ranging from the presence of any visual symptoms to severe visual field defects and loss of vision. The most common visual field defect is bitemporal hemianopia. However, other types of visual field defects may also be observed. The current study was undertaken to study the ocular manifestations in patients with intra cranial space occupying lesions at a single institute over a one-year period. Ocular manifestations include blurring of vision, visual field defects, loss of colour vision, optic disc atrophy or papilloedema. Knowledge of the more common tumors will assist the ophthalmologist in advising patients on plan of surgery, and deciding which patients should be followed and which require referral neurosurgeons or radiation oncologists. Methodology The present one year cross sectional study was conducted in the Department of Ophthalmology, KLES Dr. Prabhakar Kore hospital and Medical Research Centre, Belagavi on patients undergoing cataract surgery during the period of 1st January 2014-31st December 2014. The study was approved by the Ethical and Research Committee of Jawaharlal Nehru Medical College, Belagavi. Fifty patients with intra cranial space occupying lesions underwent a complete ophthalmic assessment and visual field analysis using the Humphrey Field Analyzer 30-2 program. Visual acuity, duration of symptoms, optic nerve head changes, pattern of visual field defects were noted. Results In present study, 50 patients with intracranial space occupying lesions are evaluated. The patient with least age in the present study was of 15yrs and the patient with maximum age was 66 yrs. The mean age of patients is 45. 90% of cases constitutes from age between 20 to 60. Male is to female ratio is 3:2. Diminution of vision (90%) was most common ocular presenting symptom. Headache was the most common systemic presenting symptom (70%) followed by seizures (2%). Maximum number of patients presented with more than one symptom. 66% of patients had the vision from 6/6-6/12, 10% patients were between 6/18-6/36 most of which presented with diminution of vision, 4% patients had vision less than 1 meter and 6% had no perception of light due to optic atrophy. Optic atrophy was the most common sign in the present study (20%). VIth cranial nerve palsy (10%) was most commonly found in the patients of present study followed by VIIIth cranial nerve palsy (04%) and III and IV cranial nerve palsy(04%). Papilloedema was found in 9 patients. Perimetry of 13 patients showed bitemporal hemianopia and 3 patient showed homonymous hemianopia. Constriction of peripheral field were present in 7 cases and 2 cases were found to be with arcuate scotoma. Most number of intracranial lesion were found peri-chismatic area (56%). 2nd most common site was found to be temporal lobe tumours (10%) followed by cerebello-pontine angle (6%). Automated perimetry of 6 cases did not show any visual field defects. Perimetry of 5 patients could not be done due to decreased visual acuity. In the present study the most commonly found type of tumour were the meningiomas (38%). 2nd most common site was found to be Pituitary Macroadenomas (32%),which were followed by Craniopharyngiomas(16%). Conclusion and interpretation If symptoms of patients of intracranial space occupying lesions are evaluated properly a detailed examination and investigations are done properly, these conditions can be diagnosed earlier. Thus prognosis is much improved as the patients gets proper treatment at an early stage. Inspite of advances made in the field of diagnostic investigations for intracranial tumours, the ophthalmologist continues to play a essential role in early detection, diagnosis and prognosis of these tumours as is indicated by a great number of ocular manifestations in our study