BDNF and TNF-α, OCT and VF parameters in Pituitary Macroadenomas patients

<p><strong>Background:</strong> Pituitary macroadenomas often cause visual pathway impairment due to optic chiasm compression. The association between systemic neurotrophic factors and visual recovery remains insufficiently explored.</p><p><strong>Methods:</strong> This prospective observational cohort study included 53 patients (106 eyes); 36 patients (72 eyes) completed a 12-month follow-up. Patients were assigned to a treatment group (surgical and/or pharmacological; n &#61; 23) or an observation group (n &#61; 13). Serum brain-derived neurotrophic factor (BDNF) and tumor necrosis factor-α (TNF-α) were measured at baseline and 12 months. Structural parameters (retinal nerve fiber layer [RNFL], ganglion cell–inner plexiform layer [GCIPL]) and visual field indices (mean sensitivity [MS], mean deviation [MD], square root of loss variance [sLV]) were assessed using optical coherence tomography and automated perimetry. </p><p><strong>Results:</strong> Serum BDNF levels differed significantly between groups at baseline (p &#61; 0.0022) and at 12 months (p &lt; 0.0001), while TNF-α levels showed no significant changes. The treatment group demonstrated significant improvement in visual field parameters and modest RNFL thickening in the right eye (p &#61; 0.0087). Baseline BDNF levels correlated inversely with OCT and visual field measures, particularly in non-functioning adenomas (R &#61; –0.70 to –0.80, p &lt; 0.01). Baseline BDNF predicted treatment qualification (AUC &#61; 0.815).</p><p><strong>Conclusions:</strong> Pituitary macroadenomas are associated with visual dysfunction and systemic neurotrophic alterations. Elevated BDNF may reflect a compensatory neuro-protective response, supporting combined molecular and ophthalmic monitoring.</p>