PDICSS, Faculty of Medicine of Porto University (FMUP), Porto, Portugal.
Department of Ophthalmology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.
Obes Surg. 2019 Jul;29(7):2174-2179. doi: 10.1007/s11695-019-03806-7.
Idiopathic intracranial hypertension (IIH) is a serious condition that is frequently associated with irreversibly vision loss, having a higher incidence among obese women. Our aims were to screen subclinical IIH in obese patients scheduled to bariatric surgery using peripapillary retinal nerve fiber layer (RNFL) thickness and to evaluate if the findings demand the possible need of a preoperative evaluation in this population.
This study included 111 eyes from 36 obese patients (86% female, body mass index > 35 kg/m) scheduled to bariatric surgery and 20 non-obese (body mass index < 25 kg/m) age-matched controls. We measured sectorial and mean RNFL thickness in a 3.5-mm-diameter circular scan centered on the optic nerve head, using optical coherence tomography (Heidelberg Spectralis SD-OCT) in all participants. Multivariate linear regression was used for adjustments.
No patient had subclinical IIH corresponding to increased RNFL thickness. However, in obese individuals, global peripapillary RNFL was thinner than in controls (104 ± 6 μm versus 99 ± 12 μm, p = 0.005). Overall, RNFL thickness was superior in the control group for all sectors. The differences reached significance for the nasal, temporal, superior temporal, and inferior temporal sectors. These differences remained even after adjusting for possible confounders (hypertension, dyslipidemia, diabetes, age, sleep apnea syndrome, and sex).
Routine screening asymptomatic obese patients undergoing bariatric surgery for IIH using RNFL thickness was not clinically relevant in our study. However, we found that severe obesity is associated with neurodegeneration independently of the other components of the metabolic syndrome, what may justify future investigation on the need of monitoring these patients.
特发性颅内高压（IIH）是一种严重的疾病，常伴有不可逆转的视力丧失，在肥胖女性中发病率较高。我们的目的是通过视盘周围视网膜神经纤维层（RNFL）厚度筛查拟行减重手术的肥胖患者的亚临床 IIH，并评估该检查在该人群中是否需要进行术前评估。
本研究纳入了 36 例肥胖患者（86%为女性，BMI>35kg/m²）的 111 只眼，这些患者拟行减重手术，并纳入 20 名非肥胖（BMI<25kg/m²）年龄匹配的对照者。所有参与者均使用光学相干断层扫描（Heidelberg Spectralis SD-OCT）测量以视盘为中心的 3.5mm 直径圆形扫描的节段性和平均 RNFL 厚度。采用多元线性回归进行调整。
无患者出现对应 RNFL 增厚的亚临床 IIH。然而，在肥胖个体中，视盘周围 RNFL 整体比对照组更薄（104±6μm比 99±12μm，p=0.005）。总体而言，对照组所有象限的 RNFL 厚度均优于观察组。在鼻侧、颞侧、上颞侧和下颞侧，这些差异具有统计学意义。即使在调整了可能的混杂因素（高血压、血脂异常、糖尿病、年龄、睡眠呼吸暂停综合征和性别）后，这些差异仍然存在。
在我们的研究中，使用 RNFL 厚度对行减重手术的无症状肥胖患者进行 IIH 的常规筛查在临床上并不相关。然而，我们发现严重肥胖与神经退行性变有关，这与代谢综合征的其他成分无关，这可能证明对这些患者进行监测的必要性。
