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Adiel Smith, Philip R Schaeur, Sangeeta R Kashyap, Kathi Wolski, Stacy A Brethauer, John P Kirwan, Richard Gans, Steven E Nissen, Deepak L Bhatt, Rishi P Singh; The Effects of Bariatric Surgery and Intensive Medical Therapy on Diabetic Retinopathy - 2 Year Data. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4411.
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Glycemic control has been shown to improve immediately after bariatric surgery in type 2 diabetes mellitus (T2DM) patients. However, any rapid change in glycemic control may cause a progression of microvascular complications. Ophthalmic outcomes following bariatric surgical treatments have rarely been reported in bariatric or ophthalmic literature. Therefore, the effect of bariatric procedures on the evolution of diabetic complications is a subject worth further analysis, specifically examining microvascular complications such as diabetic retinopathy (DR).
Data were collected on patients (n = 150) with T2DM who had Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, or medical therapy without surgery in the preceding two years. Patients were assessed with biomicroscopic fundus exam by 2 ophthalmologists at baseline and at year 2 for mild, moderate, or severe non-proliferative DR (NPDR) and for non-high risk or high risk proliferative DR (PDR). Patients are to be assessed at 2 and 5 years from baseline.
There was no statistically significant difference in presence of DR among the cohorts from baseline to year 2 (P > 0.5), as well as a highly non-significant difference in baseline and follow-up scores within each treatment group (P > 0.99). There was a statistically significant difference in mean change in hemoglobin A1C values between the medical therapy (-1.1) and surgical (-2.8 in gastric bypass, -2.7 in sleeve gastrectomy) groups (p<0.001) at 2 years.
These observations support the conclusion that, despite improved glycemic control and hemoglobin A1C, T2DM patients undergoing bariatric surgery or intensive medical therapy may not be free from microvascular ophthalmic complications such as DR; therefore, continuous retinal evaluations are necessary.
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