Obesity Surgery

, Volume 25, Issue 9, pp 1604–1609 | Cite as

The Impact of Bariatric Surgery on Diabetic Retinopathy: A Systematic Review and Meta-Analysis

  • Douglas Cheung
  • Noah J. Switzer
  • David Ehmann
  • Christopher Rudnisky
  • Xinzhe Shi
  • Shahzeer Karmali
Original Contributions

Abstract

Background

Significant reductions in glucose control immediately post bariatric surgery in patients with longstanding poor glycemic control can lead to the paradoxical progression of diabetic retinopathy (DR) in susceptible individuals. Bariatric surgery results in dramatic and immediate diabetic control postoperatively. We aimed to systematically review the literature to assess the effect of bariatric surgery on DR.

Methods

A comprehensive search of electronic databases (e.g., MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library) was completed. All randomized controlled trials, non-randomized comparison study, and case series were included. Inclusion criteria included English-speaking studies, enrolling ≥5 patients, and contained ophthalmological data on outcome of DR pre- and post bariatric surgery. Two independently reviewers screened abstracts, reviewed full text versions of all studies classified, and extracted data. All comparison studies included in the meta-analysis were assessed independently by two reviewers for methodological quality using the Cochrane Risk of Bias (RoB) tools. Disagreements were resolved by re-extraction, or third-party adjudication. Where possible and appropriate, a meta-analysis was conducted.

Results

A total of 277 studies were identified using our search criteria for screening. Four primary studies (n = 148 patients) met our inclusion criteria and were included in the systematic review. These included no randomized controlled trials and four non-randomized case series.

Patients with no preoperative DR (n = 80), following bariatric surgery, an average of 92.5 ± 7.4 % remained disease free, while 7.5± 7.4 % of patients progressed to DR.

Patients with diabetic retinopathy preoperatively (n = 68), following bariatric surgery, an average of 57.4 ± 18.5 % of patients had no change, 23.5 ± 18.7 % of patients had progression, and 19.2 ± 12.9 % of patients had improvement in their disease.

Conclusions

Progression of diabetic retinopathy is a significant issue postoperatively following bariatric surgery. Patients with a diagnosis of DR prior to surgery are at increased risk of further progression in their disease and should receive adequate counseling and evaluation prior to undergoing a surgical procedure. However, the few primary studies in this systematic review limit any conclusion. Further studies are needed to further evaluate these results.

Keywords

Bariatric surgery Diabetic retinopathy Complications Type 2 diabetes Roux-en-Y gastric bypass Systematic review 

References

  1. 1.
    Pi-Sunyer FX. The medical risks of obesity. Obes Surg. 2002;12 Suppl 1:6S–11.PubMedCrossRefGoogle Scholar
  2. 2.
    Ghoorah K, et al. Obesity and cardiovascular outcomes: a review. Eur Heart J Acute Cardiovasc Care. 2014: p. [Epub ahead of print].Google Scholar
  3. 3.
    Petrovic MA et al. Correlation between metabolic controls and changes in retina in patients having diabetes. Med Pregl. 2014;67(1–2):49–54.PubMedCrossRefGoogle Scholar
  4. 4.
    Gray SP, Jandeleit-Dahm K. The pathobiology of diabetic vascular complications–cardiovascular and kidney disease. J Mol Med (Berl). 2014;92(5):441–52.CrossRefGoogle Scholar
  5. 5.
    Gloy VL et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Lannoo M, Dillemans B. Laparoscopy for primary and secondary bariatric procedures. Best Pract Res Clin Gastroenterol. 2014;28(1):159–73.PubMedCrossRefGoogle Scholar
  7. 7.
    Aminian A et al. Risk prediction of complications of metabolic syndrome before and 6 years after gastric bypass. Surg Obes Relat Dis. 2014;10(4):576–82.PubMedCrossRefGoogle Scholar
  8. 8.
    Brethauer SA et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258(4):628–36. discussion 636–7.PubMedCentralPubMedGoogle Scholar
  9. 9.
    Heneghan HM et al. Effects of bariatric surgery on diabetic nephropathy after 5 years of follow-up. Surg Obes Relat Dis. 2013;9(1):7–14.PubMedCrossRefGoogle Scholar
  10. 10.
    Johnson BL et al. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J Am Coll Surg. 2013;216(4):545–56. discussion 556–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Leong WB, Taheri S. The role of bariatric surgery in the treatment of type 2 diabetes mellitus. J R Coll Physicians Edinb. 2012;42(3):194–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Silva RA, Morton JM, Moshfeghi DM. Severe worsening of diabetic retinopathy following bariatric surgery. Ophthalmic Surg Laser Imag Retina. 2013;44 Online(6): p. E11-4.Google Scholar
  13. 13.
    Mohite AAF, Shah S, Miras PR, et al. The effects of obesity surgery on diabetic retinopathy. Appetite. 2012;58(3):1171.Google Scholar
  14. 14.
    Zhang X, et al. Diabetic macular edema: new concepts in patho-physiology and treatment. Cell Biosci. 2014;4(27): p. [Epub ahead of print].Google Scholar
  15. 15.
    Miras AD et al. Bariatric surgery does not exacerbate and may be beneficial for the microvascular complications of type 2 diabetes. Diabetes Care. 2012;35(12):e81.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Thomas RL et al. Does bariatric surgery adversely impact on diabetic retinopathy in persons with morbid obesity and type 2 diabetes? A pilot study. J Diabetes Complications. 2014;28(2):191–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Varadhan L et al. Bariatric surgery and diabetic retinopathy: a pilot analysis. Obes Surg. 2012;22(3):515–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Leong WBTS. The progression of diabetic retinopathy post bariatric surgery. Diabetes. 2013;2013(62):A159.Google Scholar
  19. 19.
    Ros Ruiz S. Diabetic nephropathy: changes after diabetes surgery? Nutr Hosp. 2013;28 Suppl 2:57–65.PubMedGoogle Scholar
  20. 20.
    Hellgren KJ, Agardh E, Bengtsson B. Progression of early retinal dysfunction in diabetes over time: results of a long-term prospective clinical study. Diabetes. 2014;63(9):3104–11.PubMedCrossRefGoogle Scholar
  21. 21.
    Fante RJ, Gardner TW, Sundstrom JM. Current and future management of diabetic retinopathy: a personalized evidence-based approach. Diab Manag (Lond). 2013;3(6):481–94.Google Scholar
  22. 22.
    Salehi M, D’Alessio DA. Effects of glucagon like peptide-1 to mediate glycemic effects of weight loss surgery. Rev Endocr Metab Disord. 2014;15(3):171–9.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Varadhan L et al. GLP-1 agonist treatment: implications for diabetic retinopathy screening. Diabetes Res Clin Pract. 2011;94(3):e68–71.PubMedCrossRefGoogle Scholar
  24. 24.
    Varadhan L et al. The impact of improved glycaemic control with GLP-1 receptor agonist therapy on diabetic retinopathy. Diabetes Res Clin Pract. 2014;103(3):e37–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Dahl-Jorgensen K et al. Rapid tightening of blood glucose control leads to transient deterioration of retinopathy in insulin dependent diabetes mellitus: the Oslo study. Br Med J (Clin Res Ed). 1985;290(6471):811–5.CrossRefGoogle Scholar
  26. 26.
    Wang PH, Lau J, Chalmers TC. Meta-analysis of effects of intensive blood-glucose control on late complications of type I diabetes. Lancet. 1993;341(8856):1306–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Lauritzen T et al. Effect of 1 year of near-normal blood glucose levels on retinopathy in insulin-dependent diabetics. Lancet. 1983;1(8318):200–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Parving HH et al. Hemodynamic factors in the genesis of diabetic microangiopathy. Metabolism. 1983;32(9):943–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Kowluru RA. Effect of reinstitution of good glycemic control on retinal oxidative stress and nitrative stress in diabetic rats. Diabetes. 2003;52(3):818–23.PubMedCrossRefGoogle Scholar
  30. 30.
    Stefanidis D et al. Revisional bariatric surgery: perioperative morbidity is determined by type of procedure. Surg Endosc. 2013;27(12):4504–10.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Douglas Cheung
    • 1
  • Noah J. Switzer
    • 2
  • David Ehmann
    • 3
  • Christopher Rudnisky
    • 3
  • Xinzhe Shi
    • 4
  • Shahzeer Karmali
    • 2
    • 4
  1. 1.Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  2. 2.Department of SurgeryUniversity of AlbertaEdmontonCanada
  3. 3.Department of Ophthalmology and Visual SciencesUniversity of AlbertaEdmontonCanada
  4. 4.Center for the Advancement of Minimally Invasive Surgery (CAMIS)Royal Alexandra HospitalEdmontonCanada

Personalised recommendations