Prediction of Postoperative Visual Recovery After Pituitary and Anterior Skull Base Surgery with Optical Coherence Tomography: A Systematic Review and Meta-Analysis

Background: Postoperative visual recovery after surgery for pituitary and anterior skull base lesions compressing the optic apparatus remains difficult to predict. We systematically reviewed the utility of preoperative optical coherence tomography (OCT) measurements for predicting visual outcomes after surgical decompression. Methods: PubMed, Embase, and Cochrane databases were searched through August 2025. Studies assessing the associations between preoperative OCT measurements and postoperative visual outcomes were included. Postoperative visual outcomes were included tests assessing the visual fields or visual acuity. Studies with cohorts divided by visual outcome were included in a random-effects meta-analysis of mean differences (MD) in retinal nerve fiber layer (RNFL) thickness measured by OCT. Results: Forty-four studies were included comprising 2,904 patients and 4,815 eyes. Forty-one studies supported a predictive association between preoperative OCT measures and postoperative visual outcomes, although there was substantial heterogeneity in methodology. Fifteen studies fulfilled inclusion criteria for meta-analysis. In both eye- and patient-level analyses, thicker RNFL measurements were associated with better postoperative visual outcomes, particularly in temporal (MD=10.08μm, p