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Bariatric surgery does not guarantee improvement, prevention of DR

06 Sep 2017

Bariatric surgery does not appear to help thwart the progression of diabetic retinopathy (DR), with young male patients having pre-existing DR and poor preoperative glycaemic control being at greatest risk of progression, a study has found.

The study included 102 type 2 diabetes mellitus patients (median age 55 years; 33.3 percent male) who underwent bariatric surgery between 2009 and 2015. Patients were followed for a median of 4 years, and data on preoperative and postoperative weight, glycated haemoglobin (HbA1c) and annual DR screening were collected and analysed.

Prior to the operation, there were 69 patients without DR, 31 with background retinopathy, one with preproliferative retinopathy and one with proliferative retinopathy.

Following bariatric surgery, 19 percent of patients developed new DR by the first postoperative visit. Majority (70 percent) remained stable, while 11 percent improved. These proportions remained similar for each postoperative visit over time, with the incidence of developing new DR ranging from 19 to 7 percent and the proportion of patients deteriorating from previous screening ranging from 10 to 5 percent.

On logistic regression analysis, young age, male gender, high preoperative HbA1c and presence of preoperative retinopathy emerged as significant predictors of postoperative DR worsening.

Given the finding that bariatric surgery does not guarantee improvement or prevention of DR, researchers recommended that all diabetic patients attend regular DR screening after bariatric surgery to allow early detection of potentially sight-threatening changes, particularly among those with identifiable risk factors.

Additional prospective studies with longer follow-up are needed to shed light on the duration of DR progression risk.

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