Screening potential of optical coherence tomography angiography for assessing metabolic risk prior to bariatric surgery
DOI:
https://doi.org/10.14739/2310-1210.2026.4.352118Keywords:
metabolic syndrome, insulin resistance, diabetes mellitus, retinal microcirculation, optical coherence tomography angiography, microvascular density, foveal avascular zone, bariatric surgeryAbstract
Aim. To evaluate retinal microcirculation parameters using optical coherence tomography angiography (OCTA) in patients with metabolic syndrome (MS) prior to bariatric surgery and to assess their association with markers of metabolic risk.
Materials and methods. This study included 32 patients scheduled for bariatric surgery. Patients were divided into two groups: MS without type 2 diabetes mellitus (T2DM, n = 18) and MS with T2DM (n = 14). Demographic and clinical data, anthropometry, blood pressure, and metabolic laboratory parameters (fasting glucose, insulin, HbA1c, lipid profile) were recorded; insulin resistance (IR) was estimated using HOMA-IR. All participants underwent macular OCTA (6 × 6 mm scan; RTVue XR Avanti, Optovue). Vessel density in the superficial vascular plexus (SVP), deep capillary plexus (DCP) and the foveal avascular zone (FAZ) area was analyzed.
Results. Patients with MS and T2DM demonstrated significantly worse glycemic control and higher IR than those without T2DM (p ≤ 0.002). OCTA revealed reduced vessel density (VD) in both the SVP (41.2 % vs 44.8 %; p = 0.004) and DCP (43.5 % vs 47.1 %; p = 0.006), and a larger FAZ area (0.39 mm2 vs 0.31 mm2; p = 0.008) in the T2DM group. Moderate correlations were observed between OCTA metrics and metabolic parameters: SVP and DCP VD negatively correlated with HOMA-IR (ρ = -0.56 and -0.53) and HbA1c (ρ = -0.49 and -0.46), whereas FAZ positively correlated with HOMA-IR (ρ = 0.51) and fasting glucose (ρ = 0.44). ROC analysis showed the highest discriminative performance for SVP VD (AUC = 0.82 for HOMA-IR ≥2.7; AUC = 0.80 for HbA1c ≥7.0 %).
Conclusions. In bariatric surgery candidates with MS, concomitant T2DM is associated with retinal microvascular impairment detectable by OCTA. Retinal parameters correlate with insulin resistance and glycemic control, supporting the potential role of retinal parameters as biomarkers of systemic microangiopathy. SVP vessel density shows the best screening performance for identifying high metabolic risk and may assist preoperative stratification.
References
- Norris P, Gow J, Arthur T, Conway A, Fleming FJ, Ralph N. Metabolic syndrome and surgical complications: a systematic review and meta-analysis of 13 million individuals. Int J Surg. 2023;110(1):541-53. doi: https://doi.org/10.1097/JS9.0000000000000834
| 
| 
- Asghar S, Asghar S, Shahid S, Fatima M, Bukhari S, Nadeem Siddiqui S. Metabolic Syndrome in Type 2 Diabetes Mellitus Patients: Prevalence, Risk Factors, and Associated Microvascular Complications. Cureus. 2023;15(5):e39076. doi: https://doi.org/10.7759/cureus.39076
| - Durbin MK, An L, Shemonski ND, Soares M, Santos T, Lopes M, et al. Quantification of Retinal Microvascular Density in Optical Coherence Tomographic Angiography Images in Diabetic Retinopathy. JAMA Ophthalmol. 2017;135(4):370-6. doi: https://doi.org/10.1001/jamaophthalmol.2017.0080
| | - Mastropasqua R, Toto L, Mastropasqua A, Aloia R, De Nicola C, Mattei PA, et al. Foveal avascular zone area and parafoveal vessel density measurements in different stages of diabetic retinopathy by optical coherence tomography angiography. Int J Ophthalmol. 2017;10(10):1545-51. doi: https://doi.org/10.18240/ijo.2017.10.11
| | - Fu X, Ren X, Chen W, Chen D. Reduced macular thickness and vascular density in abnormal glucose metabolism patients: A meta-analysis of optical coherence tomography (OCT) and OCT angiography studies. Chin Med J (Engl). 2024;137(9):1054-68. doi: https://doi.org/10.1097/CM9.0000000000003052
| | - Lajmi H, Choura R, Zahaf A, Ben Othmen A, Hmaied W. OCT-Angiography of deep and superficial retinal vascular density changes in diabetes without diabetic retinopathy. J Fr Ophtalmol. 2024;47(1):103966. doi: https://doi.org/10.1016/j.jfo.2023.07.012
| | - Han Y, Wang X, Sun G, Luo J, Cao X, Yin P, et al. Quantitative Evaluation of Retinal Microvascular Abnormalities in Patients With Type 2 Diabetes Mellitus Without Clinical Sign of Diabetic Retinopathy. Transl Vis Sci Technol. 2022;11(4):20. doi: https://doi.org/10.1167/tvst.11.4.20
| | - Rolland M, Mohammedi K, Korobelnik JF, Cadart O, Delyfer MN, Cherifi B, et al. Analysis of Microvascular Abnormalities in Obesity: A Comparative Study with Healthy Subjects Using Swept Source Optical Coherence Tomography Angiography and Adaptive Optics. Ophthalmologica. 2022;245(5):464-75. doi: https://doi.org/10.1159/000525051
| | - Alacamli G, Kaderli ST, Edebali S, Alacamli OG, Sul S, Canbek TD, et al. Microvascular changes in obese adults detected by Optical Coherence Tomography Angiography. Rom J Ophthalmol. 2023;67(2):140-5. doi: https://doi.org/10.22336/rjo.2023.25
| - Prayitnaningsih S, Yuniasih K, Kautsarani I, Hamid AA, Iskandar A. HOMA-IR value in predicting retinal microvascular dysfunction. Narra J. 2024;4(3):e1732. doi: https://doi.org/10.52225/narra.v4i3.1732
| | - Carreras-Castañer X, Batlle-Ferrando S, Martín-Pinardel R, Hernández T, Oliva C, Vila I, et al. Bariatric Surgery Impacts Retinal Vessel Status Assessed by Optical Coherence Tomography Angiography: A Prospective 12 Months Study. J Clin Med. 2025;14(24):8644. doi: https://doi.org/10.3390/jcm14248644
| | - Chen Y, Liu Y, Cong L, Liu A, Song X, Liu W, et al. Sleeve gastrectomy improved microvascular phenotypes from obesity cohort, detected with optical coherence tomography angiography. J Diabetes. 2023;15(4):313-24. doi: https://doi.org/10.1111/1753-0407.13374
| | - Zimmet P, M M Alberti KG, Serrano Ríos M. Una nueva definición mundial del síndrome metabólico propuesta por la federación Internacional de Diabetes: fundamento y resultados [A new international diabetes federation worldwide definition of the metabolic syndrome: the rationale and the results]. Rev Esp Cardiol. 2005;58(12):1371-6. Spanish. doi: https://doi.org/10.1016/S0300-8932(05)74065-3
| | - Oliverio GW, Ceravolo I, Bhatti A, Trombetta CJ. Foveal avascular zone analysis by optical coherence tomography angiography in patients with type 1 and 2 diabetes and without clinical signs of diabetic retinopathy. Int Ophthalmol. 2021;41(2):649-58. doi: https://doi.org/10.1007/s10792-020-01621-z
| | - Nesper PL, Fawzi AA. Perfusion Deficits in Diabetes Without Retinopathy Localize to the Perivenular Deep Capillaries Near the Fovea on OCT Angiography. Ophthalmol Sci. 2024;4(5):100482. doi: https://doi.org/10.1016/j.xops.2024.100482
| | - Choi EY, Park SE, Lee SC, Koh HJ, Kim SS, Byeon SH, et al. Association Between Clinical Biomarkers and Optical Coherence Tomography Angiography Parameters in Type 2 Diabetes Mellitus. Invest Ophthalmol Vis Sci. 2020;61(3):4. doi: https://doi.org/10.1167/iovs.61.3.4
| | - Dogan B, Dogan U, Gedik B, Turkmen B, Cakir RC, Demirer ME, et al. Optical coherence tomography angiography evaluation of optic disc and retinal vascular densities in obese patients. Photodiagnosis Photodyn Ther. 2023;44:103826. doi: https://doi.org/10.1016/j.pdpdt.2023.103826
| | - Wijesingha N, Tsai WS, Keskin AM, Holmes C, Kazantzis D, Chandak S, et al. Optical Coherence Tomography Angiography as a Diagnostic Tool for Diabetic Retinopathy. Diagnostics (Basel). 2024;14(3):326. doi: https://doi.org/10.3390/diagnostics14030326
| | - Chua J, Sim R, Tan B, Wong D, Yao X, Liu X, et al. Optical coherence tomography angiography in diabetes and diabetic retinopathy. J Clin Med. 2020;9(6):1723. doi: https://doi.org/10.3390/jcm9061723
| | - ElShazly MI, Elessawy KB, Salama MM. Short-term effect of weight loss after bariatric surgery on IOP, RNFL thickness, and the optic nerve head blood flow measured by OCTA. Eur J Ophthalmol. 2022;32(4):2153-8. doi: https://doi.org/10.1177/11206721211048365
| | - Debourdeau E, Gardes G, Nocca D, Carriere I, Chiquet C, Villain M, et al. Longitudinal Effect of Bariatric Surgery on Retinal Microcirculation and Target Organ Damage: the BASTOD Study. Obes Surg. 2022;32(7):2237-46. doi: https://doi.org/10.1007/s11695-022-06064-2
| |
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