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Review
. 2021 Aug 22;10(16):3736.
doi: 10.3390/jcm10163736.

Outcomes of Diabetic Retinopathy Post-Bariatric Surgery in Patients with Type 2 Diabetes Mellitus

Ana Maria Dascalu  1   2 , Anca Pantea Stoian  3 , Alina Popa Cherecheanu  1   2 , Dragos Serban  1   4 , Daniel Ovidiu Costea  5   6 , Mihail Silviu Tudosie  1   7 , Daniela Stana  2 , Denisa Tanasescu  8 , Alexandru Dan Sabau  9 , Gabriel Andrei Gangura  1   10 , Andreea Cristina Costea  11 , Vanessa Andrada Nicolae  1   2 , Catalin Gabriel Smarandache  1   4
Affiliations
Review

Outcomes of Diabetic Retinopathy Post-Bariatric Surgery in Patients with Type 2 Diabetes Mellitus

Ana Maria Dascalu et al. J Clin Med. .

Abstract

Bariatric surgery is an emerging therapeutic approach for obese type 2 diabetes mellitus (T2DM) patients, with proven benefits for achieving target glucose control and even remission of diabetes. However, the effect of bariatric surgery upon diabetic retinopathy is still a subject of debate as some studies show a positive effect while others raise concerns about potential early worsening effects. We performed a systematic review, on PubMed, Science Direct, and Web of Science databases regarding the onset and progression of diabetic retinopathy in obese T2DM patients who underwent weight-loss surgical procedures. A total of 6375 T2DM patients were analyzed. Most cases remained stable after bariatric surgery (89.6%). New onset of diabetic retinopathy (DR) was documented in 290 out of 5972 patients (4.8%). In cases with DR at baseline, progression was documented in 50 out of 403 (12.4%) and regression in 90 (22.3%). Preoperative careful preparation of hemoglobin A1c (HbA1c), blood pressure, and lipidemia should be provided to minimize the expectation of DR worsening. Ophthalmologic follow-up should be continued regularly in the postoperative period even in the case of diabetic remission. Further randomized trials are needed to better understand the organ-specific risk factors for progression and provide personalized counseling for T2DM patients planned for bariatric surgery.

Keywords: bariatric surgery; diabetic retinopathy; progression; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart for the studies included in the review. DR: diabetic retinopathy.
Figure 2
Figure 2
Incidence of de novo DR in screened studies. Forrest plot: pooled effects-random effects model [24,25,26,27,28,29,30,31,32,33,34,35,38,39].
Figure 3
Figure 3
Progression of DR in patients with DR at baseline. Forrest plot: pooled effects–random effects model [24,25,26,27,28,29,30,31,32,33,34,35,36,37,39].
Figure 4
Figure 4
Regression of DR in patients with DR at baseline. Forrest plot: pooled effects–random effects model [24,25,26,27,28,29,30,31,32,33,34,35,36,37,39].
See this image and copyright information in PMC

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