The Impact of Bariatric Surgery on Diabetic Retinopathy: A Systematic Review and Meta-Analysis

Yu, Caberry W.; Park, Lily; Pinto, Ashlyn; Odelle, N.; Lee, Yung; Gupta, R. Rishi; Chaudhary, Varun; Doumouras, Aristithes G.

doi:10.1016/j.ajo.2020.12.033

Cited by 21 publications

(15 citation statements)

References 44 publications

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“…Bariatric surgery significantly improved Barrett’s esophagus (RD = -0.56; 95% CI: - 0.69 to - 0.43) > 1 year after surgery ( 49 ) ( Figure 3 ). Participants who underwent bariatric surgery had a significantly lower risk of diabetic retinopathy (RR = 0.17; 95% CI: 0.13 to 0.22) ( 50 ) ( Figure 3 ). There was no significant effect on pelvic organ prolapse (OR = 0.48; 95% CI: 0.22 to 1.07) or fecal incontinence (OR = 0.80; 95% CI: 0.53 to 1.21) ( 47 ) ( Figure 4 ).…”

Section: Resultsmentioning

confidence: 99%

Bariatric surgery and health outcomes: An umbrella analysis

Liao

Yin²,

Zhong³

et al. 2022

Front. Endocrinol.

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BackgroundThere is a relative lack of data that systematically investigates the breadth and validity of the association between bariatric surgery and health-related outcomes. We aimed to evaluate the quantity, validity, and credibility of evidence regarding the association between bariatric surgery and health-related outcomes using an umbrella review of meta-analyses.MethodsWe systematically searched PubMed, Embase, and the Web of Science databases from inception until December 2, 2021, to identify meta-analyses of observational or interventional studies that investigated the association between bariatric surgery and multiple health outcomes. We extracted the summary effect size and 95% confidence interval (CI) data. The Assessment of Multiple Systematic Reviews (AMSTAR-2) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines were used for methodological and evidence quality assessments, respectively.ResultsTwenty-eight studies with 82 different health-related outcomes were included in this umbrella review. Beneficial effects of bariatric surgery have been observed in cancer incidence, mortality, cardiovascular risk, polycystic ovary syndrome (PCOS), anxiety symptoms, depressive symptoms, gestational diabetes mellitus, gestational hypertension, large for gestational age (LGA), macrosomia, post-term birth, risk of kidney stones, albuminuria, urinary incontinence, fecal incontinence, Barrett’s esophagus, and diabetic retinopathy. However, adverse effects of bariatric surgery were observed for maternal anemia, perinatal mortality, congenital anomalies, preterm birth, neonatal intensive care unit (NICU) admission, intrauterine growth restriction, small for gestational age (SGA), fracture risk, upper limb fracture, suicide, self-harm, and alcohol use disorder (AUD).ConclusionsCurrent evidence suggests that bariatric surgery improves the majority of health-related outcomes; however, caution is advised given it may increase the risk of adverse mental effects, perinatal problems, and fractures.

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Section: Resultsmentioning

confidence: 99%

Bariatric surgery and health outcomes: An umbrella analysis

Liao

Yin²,

Zhong³

et al. 2022

Front. Endocrinol.

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“…A previous meta-analysis 11 assessed seven studies, compare diabetic retinopathy scores and found no difference between the two arms (bariatric surgery and medical therapy). Yu et al 19 in their meta-analysis found a lower rate of diabetic retinopathy among patients who underwent bariatric surgery, although the initial progression of diabetic retinopathy was observed, a long-term progression was not observed. A systematic review and meta-analysis that included only four studies showed the worsening of diabetic retinopathy, especially among patients with pre-existing diseases 29 .…”

Section: Discussionmentioning

confidence: 96%

Effects of Bariatric Surgery on Diabetic Retinopathy Course: A Review and Meta-Analysis.

Mirghani

Alkaabneh

Alatawi

et al. 2023

Int J Life Sci Pharm Res

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There is an increasing indication of bariatric surgery for metabolic diseases irrespective of body weight. Diabetic retinopathy is a serious disease; it is the leading cause of registered visual loss globally. Previous literature reported the deterioration of lifethreatening diabetic retinopathy after bariatric surgery. Few studies assessed the same. Our aim of the study is to assess this metaanalysis for the effects of bariatric surgery on diabetic retinopathy remission. In addition, we assessed the effects of bariatric surgery on diabetic retinopathy deterioration. We systematically searched PubMed, Cochrane Library, and the first 100 articles in Google Scholar. The search engine was limited to articles published in English from the first published article up to June 2022. The following keywords were used, bariatric surgery, metabolic surgery, diabetic retinopathy, retinopathy remission, and retinopathy deterioration. The retrieved data were entered in a datasheet detailing the author's name, year and country of publication, the methodology, and the number of patients who deteriorated was stable or improved after bariatric surgery. The most recent RevMan (version 4.4.) was used for data analysis. From our study, we found that, out of the 386 studies screened, only 26 full texts were eligible and eleven studies fulfilled the inclusion and exclusion criteria. A lower deterioration rate was observed than stability, odd ratio, 0.05, 95% CI, 0.04-0.07, P-value, <0.001. Significant heterogeneity was observed, I2=54%, P-value, 0.02, and Chi-square=21.76. in addition, a lower regression was found compared to stable retinopathy, odd ratio, 0.06, 95% CI, 0.03-0.13, P-value, <0.001. Significant heterogeneity was observed, I2=73%, P-value, 0.0002, and Chi-square=29.67. Thus, Diabetic retinopathy remains stable among patients who underwent bariatric surgery. Few remissions were observed in the short term, while few patients deteriorated. Further randomized controlled studies comparing the effect of bariatric surgery and usual diabetic care are needed.

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“…Interestingly, whilst BMS is associated with fewer cases of diabetic retinopathy, those with existing sight-threatening retinopathy may experience early worsening after BMS [ 4 ]. This strengthens the case for careful postoperative monitoring of BMS patients with visual impairment.…”

Section: Discussionmentioning

confidence: 99%

“…Visual impairments or blindness are known to occur in patients with history of malabsorptive bariatric procedures due to hypovitaminosis A [ 5 ]. Hence, this should be monitored in high-risk patients along with awareness of signs and symptoms of vitamin A deficiency like ocular surface dryness, bitot’s spots and night blindness [ 4 – 6 ].…”

Section: Discussionmentioning

confidence: 99%