title: The Effect of Bariatric Surgery on Diabetic Retinopathy: Good, Bad, or Both?
abstract: Bariatric surgery, initially intended as a weight-loss procedure, is superior to standard lifestyle intervention and pharmacological therapy for type 2 diabetes in obese individuals. Intensive medical management of hyperglycemia is associated with improved microvascular outcomes. Whether or not the reduction in hyperglycemia observed after bariatric surgery translates to improved microvascular outcomes is yet to be determined. There is substantial heterogeneity in the data relating to the impact of bariatric surgery on diabetic retinopathy (DR), the most common microvascular complication of diabetes. This review aims to collate the recent data on retinal outcomes after bariatric surgery. This comprehensive evaluation revealed that the majority of DR cases remain stable after surgery. However, risk of progression of pre-existing DR and the development of new DR is not eliminated by surgery. Instances of regression of DR are also noted. Potential risk factors for deterioration include severity of DR at the time of surgery and the magnitude of glycated hemoglobin reduction. Concerns also exist over the detrimental effects of postprandial hypoglycemia after surgery.In vivostudies evaluating the chronology of DR development and the impact of bariatric surgery could provide clarity on the situation. For now, however, the effect of bariatric surgery on DR remains inconclusive.
authors.affiliation: Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland.
authors.forename: Dora M
authors.initials: DM
authors.lastname: Gorman
authors.affiliation: Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland.; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Investigative Science, Imperial College London, London, UK.
authors.forename: Carel W
authors.initials: CW
authors.lastname: le Roux
authors.affiliation: Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland.; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Neil G
authors.identifier: 0000-0002-0961-2607
authors.initials: NG
authors.lastname: Docherty
keywords: Bariatric surgery; Diabetes mellitus; Diabetic retinopathy; Microvascular complications; Obesity