April 2014
Volume 55, Issue 13
ARVO Annual Meeting Abstract  |   April 2014
The Effects of Bariatric Surgery and Intensive Medical Therapy on Diabetic Retinopathy - 2 Year Data
Author Affiliations & Notes
  • Adiel Smith
    Cole Eye Institute / Cleveland Clinic, Cleveland, OH
  • Philip R Schaeur
    Cleveland Clinic, Cleveland, OH
  • Sangeeta R Kashyap
    Cleveland Clinic, Cleveland, OH
  • Kathi Wolski
    Cleveland Clinic, Cleveland, OH
  • Stacy A Brethauer
    Cleveland Clinic, Cleveland, OH
  • John P Kirwan
    Cleveland Clinic, Cleveland, OH
  • Richard Gans
    Cole Eye Institute / Cleveland Clinic, Cleveland, OH
  • Steven E Nissen
    Cleveland Clinic, Cleveland, OH
  • Deepak L Bhatt
    Harvard Medical School, Boston, MA
  • Rishi P Singh
    Cole Eye Institute / Cleveland Clinic, Cleveland, OH
  • Footnotes
    Commercial Relationships Adiel Smith, None; Philip Schaeur, None; Sangeeta Kashyap, None; Kathi Wolski, None; Stacy Brethauer, None; John Kirwan, None; Richard Gans, None; Steven Nissen, None; Deepak Bhatt, None; Rishi Singh, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 4411. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: 499 diabetic retinopathy • 688 retina • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials  

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