Gastric Bypass Improves Microvascular Perfusion in Patients with Obesity

Abstract

Purpose: Basic science research has shown that obesity is associated with microvascular endothelial dysfunction. However, whether bariatric surgery impacts the microvascular networks has yet to be explored. This study sought to evaluate the impact of gastric bypass in the retinal microvasculature.

Methods: Patients with obesity (BMI ≥ 35 kg/m²) scheduled to gastric bypass were consecutively recruited and included in the study. Patients were evaluated before surgery and 6-12 months after the intervention. Macular microvascular properties were evaluated using optical coherence tomography (OCT) angiography. Foveal avascular zone area, perimeter, circularity, and foveal and perifoveal vascular density (in both superficial and deep vascular plexus) were computed.

Results: In total, 40 eyes from 20 patients were included (30% male, mean BMI 43.4 ± 4.5 kg/m² (range 35.7-51.4). From these, 45% were diabetic before bariatric surgery. After surgery, there was a significant increase in foveal avascular zone circularity (from 0.85 ± 0.09 to 0.92 ± 0.07, p = 0.001) and vascular density in perifoveal deep vascular plexus (from 0.69 ± 0.12 to 0.73 ± 0.12; p = 0.04), whereas foveal avascular zone perimeter decreased (from 2.34 ± 0.37 to 2.20 ± 0.35 mm, p = 0.007). Preoperative diabetic status was not a predictor of microvascular retinal changes after bariatric surgery. However, after multivariate adjustments, the increased drop in HbA1c after the surgery remained associated with the increase in perifoveal vascular density in the deep vascular plexus (B = 0.05; 95% CI 0.05-0.10; p = 0.03).

Conclusions: Gastric bypass improves retinal microvascular perfusion as demonstrated by the increased parafoveal vascular density in the deep vascular plexus, increased foveal avascular zone circularity, and decreased foveal avascular zone perimeter.

Keywords: Bariatric surgery; Metabolic; Microvascular; Obesity; Retina.