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

作者：Brynskov Troels^*; Laugesen Caroline Schmidt; Svenningsen Annette Lykke; Floyd Andrea Karen; Sorensen Torben Lykke

来源：Obesity Surgery, 2016, 26(6): 1279-1286.

DOI：10.1007/s11695-015-1936-8

• Diabetic retinopathy
• Early worsening
• Diabetes complications
• Gastric bypass surgery
• Gastric sleeve gastrectomy
• Bariatric surgery

To investigate the need for closer perioperative monitoring of diabetic retinopathy in patients with type 2 diabetes undergoing bariatric surgery.
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.
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 HbA(1c) was 6.4 +/- 1.9 %.
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.

• 出版日期2016-6