Bariatric Surgery May Lead to Ophthalmic Complications

Patients who have undergone bariatric surgery should take the supplements prescribed to them to protect their eyes, according to a new review.

Researchers at Centro Hospitalar de Lisboa Central (Lisbon, Portugal) conducted a review of studies on the occurrence of eye conditions following bariatric surgery. The review found that all three types of bariatric surgery can cause nutrient deficiencies. For example, patients who undergo restrictive surgery, such as adjustable gastric banding (AGB), and gastric sleeve (GS), often follow an unbalanced diet, which influences their intake of the correct combination of vitamins and micronutrients.

Patients that undertake malabsorptive and mixed procedures, including Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD), suffer from a decreased surface area of the small intestine, which plays an important role in the uptake of vitamins and micronutrients. The nutrient deficiencies can cause conditions such as nyctalopia (night blindness), conjunctival and corneal xerosis, corneal ulceration and scaring, keratomalacia, pigmentary retinopathy, nystagmus (involuntary eye movements), ophthalmoplegia (paralysis of the eye muscles), and optic neuropathy.

The lower uptake of nutrients can culminate in symptomatic hypovitaminosis, and especially dangerous It is the lower intake copper and of vitamins A, E, and B1 (thiamine). Vitamin A deficiency, in particular, affects almost every component of the optic system, and has been linked to night blindness, dry eyes, corneal ulcers, and in extreme cases total blindness. According to the few studies available for the review, it seems to be more prevalent after malabsorptive bariatric surgery. The review was published in the November 2014 issue of Obesity Surgery.

“There is a risk that bariatric surgery patients, who do not take the vitamin and mineral supplements prescribed to them, could develop eye-related complications because of nutrient deficiencies,” concluded study authors Rui Azevedo Guerreiro, MD, and Rui Ribeiro, MD, PhD. “The real prevalence of these complications is unknown but the rarity of clinical reports that link nutrient deficiency with eye-related complications could also mean that no one is looking for such problems.”

Nutrient supplementation regimens should be implemented after surgery according to the procedure performed. After RYGB, supplementation with a multivitamin–mineral preparation, iron, vitamin B12, and calcium with vitamin D is common, whereas after BPD, recommended routine supplementation regimens include a multivitamin–mineral preparation, iron, vitamin B12, calcium, and fat-soluble vitamins, which include vitamin A. This need for supplementation is because the recommended daily allowance (RDA) of vitamin A, which is 3,000 IU in normal population, increases to 6,000 IU in patients with AGB, GS, and RYGB and to 33,000 IU in patients with BPD.

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