Rita Laiginhas1,2, Marta Guimarães3,4,5, Pedro Cardoso6, Hugo Santos-Sousa7,8, John Preto7, Mário Nora3,5, João Chibante2, Fernando Falcão-Reis6,9, Manuel Falcão10,11. 1. PDICSS, Faculty of Medicine of Porto University (FMUP), Porto, Portugal. 2. Department of Ophthalmology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal. 3. Unit for Multidisciplinary Research in Biomedicine (UMIB), Endocrine, Cardiovascular and Metabolic Research, University of Porto, Porto, Portugal. 4. Department of Anatomy, Institute of Biomedical Science Abel Salazar (ICBAS), University of Porto, Porto, Portugal. 5. Department of General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal. 6. Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal. 7. Department of Surgery, Centro Hospitalar e Universitário de São João, Porto, Portugal. 8. Department of Surgery, Faculty of Medicine of Porto University (FMUP), Porto, Portugal. 9. Department of Surgery and Physiology, Faculty of Medicine of Porto University (FMUP), Porto, Portugal. 10. Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal. falcao@med.up.pt. 11. Department of Surgery and Physiology, Faculty of Medicine of Porto University (FMUP), Porto, Portugal. falcao@med.up.pt.
Abstract
BACKGROUND: Idiopathic intracranial hypertension (IIH) is a serious condition that is frequently associated with irreversibly vision loss, having a higher incidence among obese women. Our aims were to screen subclinical IIH in obese patients scheduled to bariatric surgery using peripapillary retinal nerve fiber layer (RNFL) thickness and to evaluate if the findings demand the possible need of a preoperative evaluation in this population. METHODS: This study included 111 eyes from 36 obese patients (86% female, body mass index > 35 kg/m2) scheduled to bariatric surgery and 20 non-obese (body mass index < 25 kg/m2) age-matched controls. We measured sectorial and mean RNFL thickness in a 3.5-mm-diameter circular scan centered on the optic nerve head, using optical coherence tomography (Heidelberg Spectralis SD-OCT) in all participants. Multivariate linear regression was used for adjustments. RESULTS: No patient had subclinical IIH corresponding to increased RNFL thickness. However, in obese individuals, global peripapillary RNFL was thinner than in controls (104 ± 6 μm versus 99 ± 12 μm, p = 0.005). Overall, RNFL thickness was superior in the control group for all sectors. The differences reached significance for the nasal, temporal, superior temporal, and inferior temporal sectors. These differences remained even after adjusting for possible confounders (hypertension, dyslipidemia, diabetes, age, sleep apnea syndrome, and sex). CONCLUSIONS: Routine screening asymptomatic obese patients undergoing bariatric surgery for IIH using RNFL thickness was not clinically relevant in our study. However, we found that severe obesity is associated with neurodegeneration independently of the other components of the metabolic syndrome, what may justify future investigation on the need of monitoring these patients.
BACKGROUND:Idiopathic intracranial hypertension (IIH) is a serious condition that is frequently associated with irreversibly vision loss, having a higher incidence among obesewomen. Our aims were to screen subclinical IIH in obesepatients scheduled to bariatric surgery using peripapillary retinal nerve fiber layer (RNFL) thickness and to evaluate if the findings demand the possible need of a preoperative evaluation in this population. METHODS: This study included 111 eyes from 36 obesepatients (86% female, body mass index > 35 kg/m2) scheduled to bariatric surgery and 20 non-obese (body mass index < 25 kg/m2) age-matched controls. We measured sectorial and mean RNFL thickness in a 3.5-mm-diameter circular scan centered on the optic nerve head, using optical coherence tomography (Heidelberg Spectralis SD-OCT) in all participants. Multivariate linear regression was used for adjustments. RESULTS: No patient had subclinical IIH corresponding to increased RNFL thickness. However, in obese individuals, global peripapillary RNFL was thinner than in controls (104 ± 6 μm versus 99 ± 12 μm, p = 0.005). Overall, RNFL thickness was superior in the control group for all sectors. The differences reached significance for the nasal, temporal, superior temporal, and inferior temporal sectors. These differences remained even after adjusting for possible confounders (hypertension, dyslipidemia, diabetes, age, sleep apnea syndrome, and sex). CONCLUSIONS: Routine screening asymptomatic obesepatients undergoing bariatric surgery for IIH using RNFL thickness was not clinically relevant in our study. However, we found that severe obesity is associated with neurodegeneration independently of the other components of the metabolic syndrome, what may justify future investigation on the need of monitoring these patients.
Authors: Khin P Kilgore; Michael S Lee; Jacqueline A Leavitt; Bahram Mokri; David O Hodge; Ryan D Frank; John J Chen Journal: Ophthalmology Date: 2017-02-07 Impact factor: 12.079
Authors: William T Cefalu; George A Bray; Philip D Home; W Timothy Garvey; Samuel Klein; F Xavier Pi-Sunyer; Frank B Hu; Itamar Raz; Luc Van Gaal; Bruce M Wolfe; Donna H Ryan Journal: Diabetes Care Date: 2015-08 Impact factor: 19.112