case_images: PMC10353559_01
case_images: Asymmetric optic nerve head cupping of 0.55 horizontally in the right eye (left panel) and 0.85 horizontally in the left eye (right panel) (A). Optical coherence tomography of the retinal nerve fiber layer showed atrophy of the left optic nerve not only in the superior and inferior but also in the temporal portion (B). Pre-operative automated perimetry showed a bitemporal visual field defect respect to vertical meridian associated with nasal steps in the left eye (C) and right eye (D).
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case_images: Fundus examination revealed clear media, normal color, and asymmetric optic nerve head cupping of 0.55 horizontally in the right eye and 0.85 horizontally in the left eye (Figure 1A). Optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) showed bilateral superior and inferior thinning, which is consistent with glaucomatous changes; however, the left eye also showed temporal thinning (Figure 1B). Automated perimetry revealed bilateral nasal steps associated with temporal defects with respect to the vertical meridian (Figure 1C and D), raising the suspicion of an intracranial lesion other than glaucomatous change.
case_images: MRI sagittal (A) and coronal (B) T1 showed heterogeneous enhancing mass arising from pituitary fossa consistent with macroadenoma.
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case_images: Magnetic resonance imaging (MRI) of the brain (Figure 2) confirmed a 3.1x2.3 x 2.8 cm mass arising from the pituitary fossa, consistent with a macroadenoma, with mass effect on the optic chiasm, protrusion into the left cavernous sinus, and lateral displacement of the left internal carotid artery.