Structural and Functional Predictors of Visual Recovery in Chiasmal Compression Due to Sellar Tumors: Baseline MD, RNFL, and GCIPL

INTRODUCTION Optic neuropathy from sellar and suprasellar tumors is a frequent and potentially reversible cause of visual dysfunction. Predicting postoperative recovery is clinically relevant for surgical planning and patient counseling. The prognostic significance of regional OCT alterations remains unestablished. This study aimed to evaluate whether OCT quadrants predict postoperative visual recovery, and to determine which structural biomarkers independently contribute to prognosis. METHODS This retrospective study included patients with optic neuropathy secondary to sellar or suprasellar lesions surgically treated up to January 2025. Pre- and postoperative ophthalmologic evaluation included automated perimetry and spectral-domain OCT, and follow-up between 6-24 months. OCT parameters included global and sectoral RNFL and mGCIPL thickness. Random-effects hierarchical regression models were applied to account for within-patient correlation. Univariable models were performed for each covariate, followed by multivariable models incorporating baseline MD and one OCT parameter. Statistical analyses were performed using a significance level of 0.05. RESULTS Twenty-eight patients were included. In univariable analyses, neither age nor radiological evidence of chiasmal compression were significant predictors of postoperative visual outcome. Baseline MD showed a strong association with postoperative outcome (p < 0.001). All RNFL and mGCIPL sectors correlated significantly with follow-up MD (all p < 0.001). In multivariable models, baseline MD retained significance when combined with RNFL parameters, but lost significance when combined with macular GCIPL measures. RNFL parameters did not retain significance after adjustment. In contrast, three mGCIPL sectors retained independent prognostic value: nasal-superior (p = 0.014), superior (p = 0.027), and inferior (p < 0.001). DISCUSSION AND CONCLUSION Baseline MD was the most robust determinant of visual recovery after chiasmal decompression. Three GCIPL sectors, nasal-superior, superior, and inferior, emerged as independent predictors of postoperative outcome. Nasal-superior thickness highlights the vulnerability of decussating fibers at the chiasm. RNFL parameters did not add value beyond baseline MD, reflecting redundancy and possible floor effects. Clinically, sectoral macular OCT analysis should complement functional testing in preoperative evaluation.