Background <p>Pituitary macroadenomas frequently cause visual impairment through compression of the optic chiasm, and endoscopic transsphenoidal surgery remains the standard of care for achieving decompression. Despite favorable surgical outcomes in many patients, visual recovery following chiasmal decompression is heterogeneous and difficult to predict using conventional visual field testing alone. Over the past two decades, optical coherence tomography (OCT) has emerged as a noninvasive retinal imaging modality capable of quantifying structural changes in the retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) with micrometer-level resolution. A growing body of evidence suggests that preoperative RNFL thinning and GCC loss reflect irreversible axonal degeneration from chronic chiasmal compression and that these measurements carry prognostic value for postoperative visual outcomes.</p> Objective <p>To examine the current evidence linking preoperative retinal OCT parameters to visual recovery following transsphenoidal surgery for pituitary macroadenomas.</p> Methods <p>This narrative review evaluates published studies investigating the association between preoperative OCT-derived retinal structural measurements and postoperative visual outcomes in patients undergoing transsphenoidal surgery for pituitary macroadenomas.</p> Results <p>The available evidence suggests that preoperative RNFL and GCC measurements may serve as useful biomarkers of irreversible optic pathway injury and predictors of postoperative visual recovery.</p> Conclusions <p>We discuss the pathophysiological rationale, summarize key clinical studies, consider the limitations of existing evidence, and outline the clinical implications for a multidisciplinary approach that integrates neurosurgical and ophthalmic expertise in preoperative assessment.</p>