Bariatric surgery, initially intended as a weight-loss procedure, is superior to standard lifestyle intervention and pharmacological therapy for type 2 diabetes in obese individuals. Intensive medical management of hyperglycemia is associated with improved microvascular outcomes. Whether or not the reduction in hyperglycemia observed after bariatric surgery translates to improved microvascular outcomes is yet to be determined. There is substantial heterogeneity in the data relating to the impact of bariatric surgery on diabetic retinopathy (DR), the most common microvascular complication of diabetes. This review aims to collate the recent data on retinal outcomes after bariatric surgery. This comprehensive evaluation revealed that the majority of DR cases remain stable after surgery. However, risk of progression of pre-existing DR and the development of new DR is not eliminated by surgery. Instances of regression of DR are also noted. Potential risk factors for deterioration include severity of DR at the time of surgery and the magnitude of glycated hemoglobin reduction. Concerns also exist over the detrimental effects of postprandial hypoglycemia after surgery. In vivo studies evaluating the chronology of DR development and the impact of bariatric surgery could provide clarity on the situation. For now, however, the effect of bariatric surgery on DR remains inconclusive.

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Citations to this article as recorded by  

• Author response to: remission of diabetes mellitus after bariatric surgery: the putative link with worsening diabetic retinopathy and a need for ongoing postoperative follow-up retinal screening
  Karl Hage, Omar M. Ghanem
  Surgery for Obesity and Related Diseases.2024;[Epub]     CrossRef
• Impact of Bariatric Surgery on Treatment Burden and Progression of Diabetic Retinopathy
  Ariana Allen, Hemal Patel, Sandra S. Stinnett, Jullia A. Rosdahl, Stefanie Schuman
  Journal of VitreoRetinal Diseases.2024;[Epub]     CrossRef
• Role of Systemic Factors in Improving the Prognosis of Diabetic Retinal Disease and Predicting Response to Diabetic Retinopathy Treatment
  Joe Mellor, Anita Jeyam, Joline W.J. Beulens, Sanjeeb Bhandari, Geoffrey Broadhead, Emily Chew, Ward Fickweiler, Amber van der Heijden, Daniel Gordin, Rafael Simó, Janet Snell-Bergeon, Anniina Tynjälä, Helen Colhoun
  Ophthalmology Science.2024; 4(4): 100494.     CrossRef
• The Importance of Glycaemic Control Before Bariatric Surgery: Preventing Microvascular and Metabolic Complications
  Adhithya Sankar, Rajshekhar N. Mudaliar, Rupinder S. Kochhar, Lucinda K. M. Summers, Akheel A. Syed, Waseem Majeed
  Obesity Surgery.2024;[Epub]     CrossRef
• Rapid Reduction of HbA1c and Early Worsening of Diabetic Retinopathy: A Real-world Population-Based Study in Subjects With Type 2 Diabetes
  Rafael Simó, Josep Franch-Nadal, Bogdan Vlacho, Jordi Real, Ester Amado, Juana Flores, Manel Mata-Cases, Emilio Ortega, Mercedes Rigla, Joan-Anton Vallés, Cristina Hernández, Didac Mauricio
  Diabetes Care.2023; 46(9): 1633.     CrossRef
• Early microvascular complications in type 1 and type 2 diabetes: recent developments and updates
  Kalie L. Tommerdahl, Allison L. B. Shapiro, Edward J. Nehus, Petter Bjornstad
  Pediatric Nephrology.2022; 37(1): 79.     CrossRef
• New Insights into Treating Early and Advanced Stage Diabetic Retinopathy
  Rafael Simó, Cristina Hernández
  International Journal of Molecular Sciences.2022; 23(15): 8513.     CrossRef
• Response to Letter to the Editor Concerning: Adam S. et al. Improvements in Diabetic Neuropathy and Nephropathy After Bariatric Surgery: a Prospective Cohort Study
  Safwaan Adam, Jan Hoong Ho, Akheel A. Syed, Rayaz A. Malik, Handrean Soran
  Obesity Surgery.2022; 32(10): 3460.     CrossRef
• Weight management and multi-morbidity
  Carrie Ashby
  InnovAiT: Education and inspiration for general practice.2021; 14(8): 523.     CrossRef
• The Safety of Pharmacological and Surgical Treatment of Diabetes in Patients with Diabetic Retinopathy—A Review
  Wojciech Matuszewski, Angelika Baranowska-Jurkun, Magdalena Maria Stefanowicz-Rutkowska, Katarzyna Gontarz-Nowak, Ewa Gątarska, Elżbieta Bandurska-Stankiewicz
  Journal of Clinical Medicine.2021; 10(4): 705.     CrossRef
• Safety of Semaglutide
  Mark M. Smits, Daniël H. Van Raalte
  Frontiers in Endocrinology.2021;[Epub]     CrossRef
• Outcomes of Diabetic Retinopathy Post-Bariatric Surgery in Patients with Type 2 Diabetes Mellitus
  Ana Maria Dascalu, Anca Pantea Stoian, Alina Popa Cherecheanu, Dragos Serban, Daniel Ovidiu Costea, Mihail Silviu Tudosie, Daniela Stana, Denisa Tanasescu, Alexandru Dan Sabau, Gabriel Andrei Gangura, Andreea Cristina Costea, Vanessa Andrada Nicolae, Cata
  Journal of Clinical Medicine.2021; 10(16): 3736.     CrossRef
• Future perspectives in diabesity treatment: Semaglutide, a glucagon‑like peptide 1 receptor agonist (Review)
  Mariana Tilinca, Robert Tiuca, Cristina Niculas, Andreea Varga, Ioan Tilea
  Experimental and Therapeutic Medicine.2021;[Epub]     CrossRef
• Safety of injectable semaglutide for type 2 diabetes
  Rajesh Peter, Steve C. Bain
  Expert Opinion on Drug Safety.2020; 19(7): 785.     CrossRef
• Early worsening of diabetic retinopathy due to intensive glycaemic control
  Shueh Wen Lim, Peter van Wijngaarden, Colin A. Harper, Salmaan H. Al‐Qureshi
  Clinical & Experimental Ophthalmology.2019; 47(2): 265.     CrossRef
• Worsening of diabetic retinopathy with rapid improvement in systemic glucose control: A review
  Stephen C. Bain, Michael A. Klufas, Allen Ho, David R. Matthews
  Diabetes, Obesity and Metabolism.2019; 21(3): 454.     CrossRef
• Diabetische Retinopathie bei Patienten mit Diabetes mellitus
  Olga Simó-Servat, Cristina Hernández, Rafael Simó
  Kompass Ophthalmologie.2019; 5(4): 157.     CrossRef
• Diabetic Retinopathy in the Context of Patients with Diabetes
  Olga Simó-Servat, Cristina Hernández, Rafael Simó
  Ophthalmic Research.2019; 62(4): 211.     CrossRef
• MANAGEMENT OF ENDOCRINE DISEASE: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass
  Adrian T Billeter, Javier R de la Garza Herrera, Katharina M Scheurlen, Felix Nickel, Franck Billmann, Beat P Müller-Stich
  European Journal of Endocrinology.2018; 179(2): R77.     CrossRef
• Aggravation précoce de la rétinopathie diabétique lors de l’optimisation du contrôle glycémique
  S. Feldman-Billard
  Médecine des Maladies Métaboliques.2018; 12(7): 560.     CrossRef
• Semaglutide, reduction in glycated haemoglobin and the risk of diabetic retinopathy
  Tina Vilsbøll, Stephen C. Bain, Lawrence A. Leiter, Ildiko Lingvay, David Matthews, Rafael Simó, Ida Carøe Helmark, Nelun Wijayasinghe, Michael Larsen
  Diabetes, Obesity and Metabolism.2018; 20(4): 889.     CrossRef
• Glucagon-Like Peptide 1 Receptor Agonists and the Risk of Incident Diabetic Retinopathy
  Antonios Douros, Kristian B. Filion, Hui Yin, Oriana Hoi Yu, Mahyar Etminan, Jacob A. Udell, Laurent Azoulay
  Diabetes Care.2018; 41(11): 2330.     CrossRef
• Early worsening of diabetic retinopathy after rapid improvement of blood glucose control in patients with diabetes
  S. Feldman-Billard, É. Larger, P. Massin
  Diabetes & Metabolism.2018; 44(1): 4.     CrossRef
• Excess visceral adiposity is associated with diabetic retinopathy in a multiethnic Asian cohort with longstanding type 2 diabetes
  Angela Moh, Kumari Neelam, Xiao Zhang, Chee Fang Sum, Subramaniam Tavintharan, Keven Ang, Simon Biing Ming Lee, Wern Ee Tang, Su Chi Lim
  Endocrine Research.2018; 43(3): 186.     CrossRef
• GLP-1R as a Target for the Treatment of Diabetic Retinopathy: Friend or Foe?
  Rafael Simó, Cristina Hernández
  Diabetes.2017; 66(6): 1453.     CrossRef
• The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis
  Binwu Sheng, Khoa Truong, Hugh Spitler, Lu Zhang, Xuetao Tong, Liwei Chen
  Obesity Surgery.2017; 27(10): 2724.     CrossRef
• Bariatric Surgery for Adolescents with Type 2 Diabetes: an Emerging Therapeutic Strategy
  M. A. Stefater, T. H. Inge
  Current Diabetes Reports.2017;[Epub]     CrossRef
• The role of bariatric surgery to treat diabetes: current challenges and perspectives
  Chrysi Koliaki, Stavros Liatis, Carel W. le Roux, Alexander Kokkinos
  BMC Endocrine Disorders.2017;[Epub]     CrossRef