1. In diabetic retinopathy patients undergoing Roux-en-Y gastric bypass, there was no significant progression of diabetic retinopathy scores after 2 years of follow-up.
2. A significant worsening of diabetic retinopathy scores was noted in control subjects who did not undergo gastric surgery.
Evidence Rating Level: 3 (Average)
Study Rundown: Roux-en-Y bypass has been linked to sustained weight loss in 90% of patients, with concomitant improvement of obesity-associated complications, including type II diabetes mellitus. While the efficacy of bariatric surgery for diabetic patients has been established, little is known regarding the effect of the surgery and concomitant weight loss on the progression of diabetic retinopathy (DR). This study found no significant change in diabetic retinopathy grading scores in patients 2 years after Roux-en-Y gastric surgery. This was in contrast with a matched group of DR patients managed with medical therapy, who experienced significant deterioration of their DR over the same period. These results illustrate the potential efficacy of Roux-en-Y surgery in limiting the progression of DR. However, this study suffers from a number of methodological drawbacks including significant baseline differences in the treatment and control groups. The control group tended to be more male, older, of a lower BMI, and, most notably, farther along in their diabetic course, with increased time with diabetes, incidence of insulin dependence, and baseline DR grading scores. Such deficiencies, coupled with the small simple size, limit the generalizability of these results.
In-Depth [case-control study]: Data was collected via a National Health Service (NHS) Database from 21 cases with type II diabetes and grade 1 or higher DR who underwent a Roux-en-Y gastric bypass procedure and had relevant retinal images 2 years post-operatively. Twenty-four individuals with type II diabetes and retinopathy of grade 1 or higher served as the control group. Retinal scans or ophthalmic documentation were utilized to assess DR by a blinded ophthalmologist and graded at baseline and 2 years later. In the treatment group, DR grading scores increased from 1.29 at baseline to 1.52 at 2 years post-op; however this change was not significant (p = 0.14). A significant increase in DR from 2.21 at baseline to 2.58 at two year follow-up was noted in the control group (p = 0.03). There was no significant difference in the change of DR scores between the treatment and control groups (p = 0.13).
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