Department of Ophthalmology, Västmanland County Hospital, Västerås, Sweden.
Department of Surgical Sciences, Upper Gastrointestinal Surgery, Uppsala University, Uppsala, Sweden.
Acta Ophthalmol. 2018 May;96(3):279-282. doi: 10.1111/aos.13555. Epub 2017 Aug 31.
To study the occurrence and level of diabetic retinopathy (DRP) before and after planned bariatric surgery and to investigate potential risk factors for deterioration of DRP.
The Scandinavian Obesity Surgery Registry (SOReg) was used to identify diabetic patients who underwent gastric bypass (GBP) surgery at three centres in Sweden during 2008-2010. Information regarding DRP screening was obtained from ophthalmological patient charts. Patients who had DRP screening before and after GBP surgery were included in the study.
The survey included 117 patients. Mean age was 50 (SD 10) years, body mass index (BMI) 43 (SD 8) kg/m and HbA1c 64 (SD 18) mmol/mol before surgery. One year post-GBP, BMI was reduced to 31 (SD 6) kg/m . HbA1c was 43 (SD 10) mmol/mol, and in 66% (77/117) treatment for diabetes had been discontinued. Occurrence of DRP before GBP was as follows: no DRP 62%, mild 26%, moderate 10%, severe 0% and proliferative DRP 2%. No significant changes in occurrence of DRP after surgery were observed. Twelve patients (16%) developed mild DRP. In seven patients with pre-existing DRP, deterioration was observed and two of these patients required treatment for sight-threatening DRP. No association between preoperative BMI, HbA1c or reduction in HbA1c and worsening of DRP was found.
In a majority of patients, no deterioration of DRP following GBP was observed. Screening for DRP before planned surgery is recommended for all diabetic patients about to undergo bariatric surgery to identify any pre-existing DRP.
研究计划减肥手术后糖尿病视网膜病变（DRP）的发生和水平，并探讨 DRP 恶化的潜在危险因素。
使用斯堪的纳维亚肥胖手术登记处（SOReg）确定 2008-2010 年期间在瑞典三个中心接受胃旁路（GBP）手术的糖尿病患者。通过眼科患者病历获得关于 DRP 筛查的信息。将在 GBP 手术前后进行 DRP 筛查的患者纳入研究。
该调查包括 117 名患者。平均年龄为 50（SD 10）岁，手术前的体重指数（BMI）为 43（SD 8）kg/m2，HbA1c 为 64（SD 18）mmol/mol。GBP 术后 1 年，BMI 降低至 31（SD 6）kg/m2，HbA1c 为 43（SD 10）mmol/mol，77/117（66%）的患者停止了糖尿病治疗。GBP 前 DRP 的发生率如下：无 DRP 占 62%，轻度占 26%，中度占 10%，重度占 0%，增殖性 DRP 占 2%。手术后 DRP 的发生无明显变化。12 名患者（16%）出现轻度 DRP。在 7 名存在预先存在的 DRP 的患者中，观察到病情恶化，其中 2 名患者需要治疗威胁视力的 DRP。未发现术前 BMI、HbA1c 或 HbA1c 降低与 DRP 恶化之间存在关联。
在大多数患者中，GBP 后未观察到 DRP 恶化。建议所有即将接受减肥手术的糖尿病患者在计划手术前进行 DRP 筛查，以确定任何预先存在的 DRP。
