Analysis of clinical factors affecting retinal ganglion cell complex thickness reduction in patients with childhood‑onset craniopharyngioma

Visual impairment characterized by damage to nerve cells of the optic nerve and retina is a critical component of postoperative care in childhood-onset craniopharyngioma (CP) survivors. The study aims to assess retinal ganglion cell complex (GCC) thickness and analyze clinical factors influencing its reduction in CP patients using optical coherence tomography (OCT). Sixty eyes of 32 patients with childhood-onset craniopharyngioma (CP) and 78 eyes of 39 age- and sex-matched healthy controls were enrolled. All CP patients underwent comprehensive endocrine evaluation before and after surgery. Preoperative assessments included clinical, endocrinological, and tumor-related parameters. Postoperatively, all participants (both study and control groups) received a complete ophthalmologic examination, including optical coherence tomography (OCT) imaging with the RTVue XR Avanti system. The following OCT-derived parameters were analyzed: average ganglion cell complex thickness (avgGCC), superior ganglion cell complex thickness (supGCC) and inferior ganglion cell complex thickness (infGCC), global loss of volume (GLV), and focal loss of volume (FLV). There were significant differences in avgGCC (82 μm vs. 100 μm, p < 0.0001), supGCC (79.5 μm vs. 100 μm, p < 0.0001), infGCC (83 μm vs. 100 μm, p < 0.0001), FVL (7.4%, vs. 0.4%, p < 0.0001), and GVL (14.4% vs. 1.3%, p < 0.0001) between patients with CP and healthy children. Pre-diagnosis symptoms associated with reduced GCC thickness included growth retardation on supGCC, delayed puberty on avgGCC, supGCC, infGCC, GLV, and adrenal insufficiency on FLV. There were correlations between tumor volume, maximum tumor diameter and avgGCC, supGCC, infGCC, FLV, and GLV. Assessment of retinal GCC is beneficial for evaluating structural damage to retinal nerve cells in patients with CP. GCC examination may serve as a useful adjunct to standard ophthalmologic evaluation. • Childhood-onset craniopharyngioma (CP) survivors are at risk of visual impairment due to optic nerve and retinal damage. • Optical coherence tomography (OCT) is a valuable tool for detecting structural changes in retinal layers. • Significant thinning of retinal ganglion cell complex (GCC) in all locations and increased loss of retinal volume (FLV and GLV) were found in CP patients compared to healthy controls. • Pre-diagnosis symptoms such as growth retardation and delayed puberty are associated with greater GCC reduction. • Tumor volume and maximum tumor diameter correlate with structural retinal damage detected on OCT.