Abstract
The immediate impact of rapid glucose lowering induced by bariatric surgery on diabetic retinopathy (DR) progression remains unclear. We present 3-year changes in the best-corrected visual acuity and DR grade in a retrospective observational study of 32 morbidly obese patients (64 eyes) who underwent Roux-en-Y-gastric bypass surgery. We found that despite overall benefits in vision, there was an initial progression from no retinopathy to background retinopathy in 18.9% and 21.7% at years 1 and 2 respectively. Patients with pre-proliferative DR at baseline were at increased risk of developing sight-threatening DR. We recommend that patients with diabetes undergoing bariatric surgery have a baseline visual acuity, macular optical coherent tomography and diabetic retinopathy grading from wide-field digital imaging to identify those at risk of sight-threatening diabetic retinopathy.
Highlights
Bariatric surgery is recognised as an effective treatment for achieving significant weight loss and in inducing significant and rapid improvement in glycaemic control with, in some cases, remission of type 2 diabetes (T2D) [1]
There are concerns regarding the acute impact of rapid glucose lowering induced by bariatric surgery on diabetic retinopathy (DR) progression, with some studies showing a paradoxical worsening of DR [3], no effect [4] or an improvement in DR [5]
To observe the impact of bariatric surgery on Best-Corrected Visual Acuity (BCVA) and DR grade, we present the results of a 3 year retrospective observational study of 32 morbidly obese patients (64 eyes) with T2D following Roux-en-Y-gastric bypass (RYGB) surgery at Derby Teaching Hospitals, a regional centre for bariatric surgery
Summary
The immediate impact of rapid glucose lowering induced by bariatric surgery on diabetic retinopathy (DR) progression remains unclear. We present 3-year changes in the BestCorrected Visual Acuity and DR grade in a retrospective observational study of 32 morbidly obese patients (64 eyes) who underwent Roux-en-Y-gastric bypass surgery. We found that despite overall benefits in vision, there was an initial progression from no retinopathy to background retinopathy in 18.9% and 21.7% at year 1 and 2 respectively. Patients with preproliferative DR at baseline were at increased risk of developing sight-threatening DR. We recommend that patients with diabetes undergoing bariatric surgery have a baseline visual acuity, macular Optical Coherent Tomography and diabetic retinopathy grading from widefield digital imaging to identify those at risk of sight-threatening diabetic retinopathy
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