Bariatric Surgery and the Neuro-Ophthalmologist

Abstract

Background As the prevalence of obesity increases, so are the prevalences of weight related diseases and the incidence of surgical procedures to promote weight loss. It is important for neuro-ophthalmologists to be familiar with these procedures and possible downstream effects on afferent and efferent visual function. Evidence acquisition Review of ophthalmology, neurology, general surgery, obesity, endocrinology, nutrition, psychiatry and neurosurgery literature. Results Bariatric surgery is a safe and effective treatment for weight loss in obese individuals. There is level IV evidence that it is associated with improvement in idiopathic intracranial hypertension(IIH). Laboratory nutrient deficiencies are common following some types of bariatric procedures. Symptomatic deficiencies are less common but can be devastating. Thiamine deficiency can cause nystagmus and other symptoms in weeks to months following surgery, B12 or copper deficiency can cause optic neuropathy in the years to decades following bariatric surgery. Conclusions Bariatric surgery may be a treatment for IIH. Postoperative vitamin deficiencies may present with nystagmus, optic neuropathy, nyctalopia and/or ophthalmoparesis weeks to years after surgery.

Idiopathic intracranial hypertension: Contemporary review and implications for the otolaryngologist

“…Weight‐reduction surgery is considered for patients unable to achieve sufficient loss via diet and lifestyle changes alone . The type of procedure performed does not appear to significantly affect outcomes as long as losses are durable.…”

“…6 Weight-reduction surgery is considered for patients unable to achieve sufficient loss via diet and lifestyle changes alone. 11,19,20,40,60 The type of procedure performed does not appear to significantly affect outcomes as long as losses are durable. One systematic review demonstrated that up to 92% of patients undergoing bariatric surgery resolved their visual field deficits.…”

Bariatric Surgery as a Treatment for Idiopathic Intracranial Hypertension in a Male Adolescent: Case Report

“…8 In adults with obesity-related IIH, weight reduction -either by diet or bariatric surgery -improved vision, with papilledema and IIH resolution. 9,10 Surgical interventions were associated with 100% of postoperative IIH resolution against 66.7% in the non-surgical group (95%CI 45.6-87.8; p<0.005). 11 Some authors even consider bariatric surgery as the procedure of choice for severely obese patients with IIH.…”

Bariatric surgery and its impact on pseudotumor cerebri: A case report

“…In recent years this option has begun to gain interest because of its multiple health benefits to morbidly obese patients. 3 However, the current literature consists only of case reports or small retrospective studies that suggest that bariatric surgery is an effective treatment for pseudotumor cerebri. 1 , 4 , 5 The reports in the literature lack substantial data supporting the benefit from weight loss surgery.…”