Ocular problems and bariatric surgery

Antoine Valembois, Gary Olders, Florence Aerts, Jean-Paul Thissen, Antonella Boschi Published in the journal : May 2021 Category : Ophtalmology

Objectives

- To report a case of severe hypovitaminosis A, responsible for bilateral blindness, which occurred 10 years after a bilio-pancreatic bypass.

- To recall the necessity of an early vitamin supplementation to obtain a remission of visual manifestations.

Method

Case report, review of the literature

Results

A 36-year-old man, who was followed-up and treated for keratoconus, was referred to our unit due to a progressive bilateral visual loss. The medical history revealed a gastric bypass surgery 10 years earlier, which had been followed by a biliopancreatic bypass.

Ophthalmological examination revealed bilateral blindness and severe dry eyes. The fundus was only visible at the right eye. On fundoscopy, the optic nerve was pale, and the retina showed diffuse pigmentary changes. There was a lack of response on the electroretinogram. Biological analysis revealed undetectable vitamin A levels, along with low levels of Cu, Zn, 25OHvitamin D, and vitamin E. The diagnosis of retinopathy and optic neuropathy due to nutritional deficiencies was made. Following treatment with vitamin supplementation, vision improved, yet in the right eye only.

Conclusions

Vitamin A deficiency associated with irreversible blindness is a clinical picture that is only rarely encountered in industrialized countries. Digestive malabsorption, especially if induced by bariatric surgery with biliopancreatic diversion, is a common cause. Recognition of the early symptoms, including xerophthalmia and night blindness, is essential to enable curative treatment to be initiated.

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Retinal vein occlusion: what is the role of thrombophilia?

Gianfilippo Nifosì Published in the journal : November 2017 Category : Ophtalmology

Retinal vein occlusion is the second most common retinal vascular disease, with an increased incidence in elderly patients with cardiovascular risk factors. While ocular hypertension appears to be the main local factor, thrombophilia plays a major role in young subjects, in people without risk factors, in the presence of positive personal history for venous thromboembolic disease, during pregnancy, as well as in the event of bilateral occlusion. In these circumstances, congenital or acquired predisposing factors should be searched for. The role of new local treatments, anticoagulant therapy, and long-term prophylaxis is discussed in the present article.

Key Words

Thrombophilia, retinal circulation, hyperviscosity, anticoagulation

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