Troels Brynskov1,2, Caroline Schmidt Laugesen3, Annette Lykke Svenningsen4, Andrea Karen Floyd5, Torben Lykke Sørensen3,6. 1. Department of Ophthalmology, Copenhagen University Hospital Roskilde, Køgevej 7-13, 4000, Roskilde, Denmark. troels@brynskov.com. 2. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. troels@brynskov.com. 3. Department of Ophthalmology, Copenhagen University Hospital Roskilde, Køgevej 7-13, 4000, Roskilde, Denmark. 4. Department of Internal Medicine, Copenhagen University Hospital Holbæk, Holbæk, Denmark. 5. Department of Bariatric Surgery, Copenhagen University Hospital Køge, Køge, Denmark. 6. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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.
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.
Authors: R Murphy; Y Jiang; M Booth; R Babor; A MacCormick; H Hammodat; G Beban; R M Barnes; A L Vincent Journal: Diabet Med Date: 2015-02-26 Impact factor: 4.359
Authors: Hille W van Dijk; Frank D Verbraak; Pauline H B Kok; Marilette Stehouwer; Mona K Garvin; Milan Sonka; J Hans DeVries; Reinier O Schlingemann; Michael D Abràmoff Journal: Invest Ophthalmol Vis Sci Date: 2012-05-14 Impact factor: 4.799
Authors: Francesco Rubino; Michel Gagner; Paolo Gentileschi; Subhash Kini; Shoji Fukuyama; John Feng; Ed Diamond Journal: Ann Surg Date: 2004-08 Impact factor: 12.969
Authors: Ana Ramos-Levi; Andres Sanchez-Pernaute; Pilar Matia; Lucio Cabrerizo; Ana Barabash; Carmen Hernandez; Alfonso Calle-Pascual; Antonio Torres; Miguel Rubio Journal: Obes Surg Date: 2013-10 Impact factor: 4.129
Authors: Alexander D Miras; Ling Ling Chuah; Gerassimos Lascaratos; Sana Faruq; Ajay A Mohite; Priya R Shah; Mahi Gill; Sabrina N Jackson; Desmond G Johnston; Torsten Olbers; Carel W le Roux Journal: Diabetes Care Date: 2012-12 Impact factor: 19.112
Authors: Karen J Coleman; Sebastien Haneuse; Eric Johnson; Andy Bogart; David Fisher; Patrick J O'Connor; Nancy E Sherwood; Steve Sidney; Mary Kay Theis; Jane Anau; Emily B Schroeder; Rebecca O'Brien; David Arterburn Journal: Diabetes Care Date: 2016-06-06 Impact factor: 19.112