Supplementary Material for: Optical coherence tomography abnormalities as the presenting sign of an involuted sellar/suprasellar mass

Introduction: Pituitary adenomas are benign tumors that can lead to visual loss through compression of the optic chiasm. Patients with pituitary adenomas often present with visual field defects (commonly bitemporal hemianopia), but some may be asymptomatic. In such cases, abnormalities may only be detected through visual field testing or optical coherence tomography (OCT) of the ganglion cell-inner plexiform layer (GCIPL), may provide a more sensitive method for detecting such abnormalities.

Case presentation: A 72-year-old man was incidentally found to have binasal OCT-GCIPL thinning during a routine eye examination. Visual acuity was 20/20 in both eyes. Pupils were equal and reactive without a relative afferent pupillary defect. His Humphrey 24-2 SITA-Fast visual field test results were normal. An MRI revealed a non-enhancing (cystic) sellar/suprasellar mass measuring 1.7 cm craniocaudal by 2.1 cm anteroposteriorly, without associated optic chiasm compression. The lesion was suspected to be either a cystic pituitary adenoma or a Rathke’s cleft cyst. Follow-up examination one year later showed all findings remained stable, including an unchanged visual acuity, visual fields, OCT-GCIPL and MRI.

Conclusion: The binasal thinning observed on OCT-GCIPL in this case, despite the absence of chiasmal compression on MRI, is suggestive of previous compression of the optic chiasm. This case highlights the potential for spontaneous regression of pituitary adenomas and underscores the importance of OCT-GCIPL as a vital tool for detecting optic chiasmal damage.

引言：垂体腺瘤（pituitary adenomas）是良性肿瘤，可通过压迫视交叉导致视力丧失。垂体腺瘤患者常出现视野缺损（多为双颞侧偏盲），但部分患者可无明显症状。此类情况下，异常仅可通过视野检查或神经节细胞-内丛状层（ganglion cell-inner plexiform layer, GCIPL）光学相干断层扫描（optical coherence tomography, OCT）检出，后者或为检测此类异常的更敏感手段。

病例报告：一名72岁男性在常规眼科检查中偶然发现双眼鼻侧OCT-GCIPL变薄。双眼视力均为20/20（对应国际标准视力表1.0）。瞳孔等大等圆，对光反射灵敏，无相对性传入性瞳孔障碍。其汉弗莱24-2 SITA-Fast视野检查结果正常。磁共振成像（magnetic resonance imaging, MRI）显示鞍区/鞍上区存在一非强化囊性肿块，头尾径1.7cm，前后径2.1cm，未伴视交叉受压。该病变疑似为囊性垂体腺瘤或Rathke裂囊肿。一年后的随访检查显示所有结果均保持稳定，包括视力、视野、OCT-GCIPL及MRI均无变化。

结论：本案例中，尽管MRI未显示视交叉受压，但OCT-GCIPL检出的双眼鼻侧变薄提示患者曾存在视交叉受压。该案例凸显了垂体腺瘤自发消退的可能性，并强调了OCT-GCIPL作为检测视交叉损伤重要工具的临床价值。