Rita Laiginhas1,2, Marta Guimarães3,4,5, Pedro Cardoso6, Hugo Santos-Sousa7,8, John Preto7,8, Mário Nora3,4, 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. Department of General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal. 4. Unit for Multidisciplinary Research in Biomedicine (UMIB), Endocrine, Cardiovascular and Metabolic Research, University of Porto, Porto, Portugal. 5. Department of Anatomy, Institute of Biomedical Science Abel Salazar (ICBAS), University of Porto, Porto, Portugal. 6. Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal. 7. Department of Surgery, Centro Hospitalar e Universitário São João, Porto, Portugal. 8. Department of Surgery, Faculty of Medicine of Porto University (FMUP), 4200-319, Porto, Portugal. 9. Department of Surgery and Physiology, Faculty of Medicine of Porto University (FMUP), 4200-319, Porto, Portugal. 10. Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal. falcao@med.up.pt. 11. Department of Surgery and Physiology, Faculty of Medicine of Porto University (FMUP), 4200-319, Porto, Portugal. falcao@med.up.pt.
Abstract
PURPOSE: Obese patients have neurodegeneration of the optic nerve demonstrated by decreased peripapillary nerve fiber layer. Whether bariatric surgery reverses this neurodegenerative process has not been explored. We aimed to evaluate the impact of bariatric surgery in the structure of the retina and optic nerve. METHODS: Multicentric observational study. Obese patients scheduled for bariatric surgery were consecutively recruited and included in the study and evaluated before and 6-12 months after the intervention. The retinal structure was evaluated as retinal thickness in the different retinal layers in the foveal, perifoveal, and parafoveal regions using optical coherence tomography. Choroidal thickness and optic nerve retinal nerve fiber layer thickness were also evaluated. RESULTS: Eighty eyes from 40 participants were included. Globally, we found a significant thickening of the retina after bariatric surgery (foveal: 273.5 (21.5) μm vs 280.0 (28.8) μm, p < 0.001; parafoveal 332.4 ± 17.8 μm vs 336.6 ± 15.9 μm, p = 0.003; perifoveal: 293.4 ± 13.8 μm vs 295.7 ± 14.9 μm; p = 0.001), whereas no significant differences were found for the ganglion cell layer, choroid, or peripapillary nerve fiber layer thickness. The retinal thickening was confined to inner retinal layers and was independent of the diabetic status of the patients. After multivariate adjustment, HbA1c variation, preoperative C-peptide, preoperative hypertension, preoperative OSA, and preoperative LDL and TG levels seem to be clinical predictors of retinal thickening. CONCLUSIONS: We found a significant thickening of the retina after bariatric surgery that was independent of the diabetic status. The thickening was confined to inner retinal layers and may represent and improve perfusion. The peripapillary nerve fiber layer remained unchanged after the surgery.
PURPOSE: Obese patients have neurodegeneration of the optic nerve demonstrated by decreased peripapillary nerve fiber layer. Whether bariatric surgery reverses this neurodegenerative process has not been explored. We aimed to evaluate the impact of bariatric surgery in the structure of the retina and optic nerve. METHODS: Multicentric observational study. Obese patients scheduled for bariatric surgery were consecutively recruited and included in the study and evaluated before and 6-12 months after the intervention. The retinal structure was evaluated as retinal thickness in the different retinal layers in the foveal, perifoveal, and parafoveal regions using optical coherence tomography. Choroidal thickness and optic nerve retinal nerve fiber layer thickness were also evaluated. RESULTS: Eighty eyes from 40 participants were included. Globally, we found a significant thickening of the retina after bariatric surgery (foveal: 273.5 (21.5) μm vs 280.0 (28.8) μm, p < 0.001; parafoveal 332.4 ± 17.8 μm vs 336.6 ± 15.9 μm, p = 0.003; perifoveal: 293.4 ± 13.8 μm vs 295.7 ± 14.9 μm; p = 0.001), whereas no significant differences were found for the ganglion cell layer, choroid, or peripapillary nerve fiber layer thickness. The retinal thickening was confined to inner retinal layers and was independent of the diabetic status of the patients. After multivariate adjustment, HbA1c variation, preoperative C-peptide, preoperative hypertension, preoperative OSA, and preoperative LDL and TG levels seem to be clinical predictors of retinal thickening. CONCLUSIONS: We found a significant thickening of the retina after bariatric surgery that was independent of the diabetic status. The thickening was confined to inner retinal layers and may represent and improve perfusion. The peripapillary nerve fiber layer remained unchanged after the surgery.