Bariatric surgery is currently an established treatment method ,as part of complex and interdisciplinary therapeutic approach to patients with severe obesity and metabolic syndrome .The indications for bariatric surgery in patients aged 18-65 years include BMI >_ 40Kg/m2 or BMI 35-40 Kg/m2 with co- morbidities , the severity of which is expected to decrease with body mass reduction .Previous data from the Mannheim Obesity study have observed that signs of endothelial dysfunction can occur in obese patients also in absence of metabolic syndrome. The arteriole - to-venule ratio (AVR) of retinal vessel is one of the most important static parameter of endothelial function associated with cardiovascular disease (CVD),independent of classic cardiovascular risk factors.
The American Diabetes Association recommends bariatric surgery "as an option to treat T2DM in appropriate surgical candidates.. when hyper-glyceamia is inadequately controlled despite lifestyle and optimal medical therapy".
The recently developed adiponectin/leptin ratio(ALR) correlates with Insulin Resistance (IR) is better than adiponectin or leptin alone.This emerging index decreases with increasing number of cardio-metabolic risk factors reflecting the functionality of adipose tissue and negatively correlates with markers of low -grade chronic subclinical inflammation.
Optical coherence tomography (OCT) has proven to be a highly valuable and commonly used retinal imaging modality.It is anon-invasive technique ,similar to ultrasound.With OCT ,reflected light is used to produce cross-sectional and 3-D images of the retina .
According to studies analysing peripheral vascular stiffness, it has been suggested that the macro-vascular system might be less sensitive to early metabolic changes after bariatric surgery than microvascular system; changes also have been reported to occur in the first weeks after surgery, without significant changes years after procedure.
Data from our preliminary observational perspective study will be useful to better plan primary prevention in the specific population of bariatric patients , that can take into account classical and disease -specific risk factors,along as their relative evolution in post- operatory period after bariatric surgery.
Data from OCT study of the retinal vessel ,as marker of endothelial dysfunction, will be useful to better assess the clinical utility of this diagnostic method of relatively recent introduction in the context of primary cardiovascular prevention.