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Monitoring of Diabetic Retinopathy in relation to Bariatric Surgery: a Prospective Observational Study

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Abstract

Background

To investigate the need for closer perioperative monitoring of diabetic retinopathy in patients with type 2 diabetes undergoing bariatric surgery.

Methods

Prospective observational clinical study of 56 patients with type 2 diabetes undergoing bariatric surgery. The patients were examined with 7-field fundus images and optical coherence tomography scans 2 weeks before and 1, 3, 6 and 12 months after bariatric surgery. Worsening was defined as a two-step change in the Wisconsin Epidemiologic Study of Diabetic Retinopathy scale or appearance or worsening of macular edema. Postoperative changes were analyzed in a mixed model.

Results

Six patients (11 %) had any worsening at any visit, and three (5 %) persisted at 1 year. Of the 24 patients with preoperative retinopathy, 4–13 % worsened and 9–22 % improved, with significant overall improvement at 6 months (p = 0.01). Only one (3%) of the 32 patients without preoperative diabetic retinopathy had a transient worsening at 6 months. No patients developed macular edema, but the whole cohort had a minor increase in center point foveal thickness that peaked 6 months postoperatively. The patients were required to have good glucose control preoperatively where HbA1c was 6.4 ± 1.9 %.

Conclusions

Diabetic retinopathy was clinically stable after bariatric surgery, and none of the observed changes would have resulted in a changed screening interval at our center. This supports adherence to regular diabetic retinopathy screening guidelines following bariatric surgery in well-controlled patients. A clinically negligible but statistically significant foveal thickening 6 months postoperatively warrants further study.

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Abbreviations

DCCT:

Diabetes Control and Complications Trial

ETDRS:

Early Treatment Diabetic Retinopathy Study

OCT:

Optical coherence tomography

WESDR:

Wisconsin Epidemiologic Study of Diabetic Retinopathy

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Authors and Affiliations

  1. Department of Ophthalmology, Copenhagen University Hospital Roskilde, Køgevej 7-13, 4000, Roskilde, Denmark

    Troels Brynskov, Caroline Schmidt Laugesen & Torben Lykke Sørensen

  2. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Troels Brynskov & Torben Lykke Sørensen

  3. Department of Internal Medicine, Copenhagen University Hospital Holbæk, Holbæk, Denmark

    Annette Lykke Svenningsen

  4. Department of Bariatric Surgery, Copenhagen University Hospital Køge, Køge, Denmark

    Andrea Karen Floyd

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  1. Troels Brynskov
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  2. Caroline Schmidt Laugesen
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  4. Andrea Karen Floyd
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Corresponding author

Correspondence to Troels Brynskov.

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Conflicts of Interest

Troels Brynskov was supported by unrestricted grants from the following nonprofit organizations: Fight for Sight Denmark, the Bagenkop Nielsen Myopia Foundation, and the Research Foundation of Region Zealand (TB). The other coauthors declare no conflicts of interest.

Ethical Approval

All procedures were in accordance with the regional ethical research committee (approval #SJ-205) and with the 1964 Helsinki declaration and its later amendments.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Brynskov, T., Laugesen, C.S., Svenningsen, A.L. et al. Monitoring of Diabetic Retinopathy in relation to Bariatric Surgery: a Prospective Observational Study. OBES SURG 26, 1279–1286 (2016). https://doi.org/10.1007/s11695-015-1936-8

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  • DOI: https://doi.org/10.1007/s11695-015-1936-8

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