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Rapid recovery of night blindness due to obesity surgery after vitamin A repletion therapy
  1. Y Spits,
  2. J-J De Laey,
  3. B P Leroy
  1. Department of Ophthalmology and Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium
  1. Correspondence to: B P Leroy Department of Ophthalmology and Centre for Medical Genetics, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium; bart.leroyugent.be

https://doi.org/10.1136/bjo.2003.022459

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    Night blindness is the most common and earliest symptom of vitamin A deficiency.1 The latter can be caused by general malnutrition, malabsorption of vitamin A, or impaired vitamin A metabolism due to liver disease.2

    Several surgical methods are currently used for the treatment of obesity. In the Scopinaro procedure, a biliopancreatic bypass is combined with a bypass of part of the small bowel, thus promoting intestinal malabsorption.3

    The fat soluble vitamin A can exist as retinol, its ester, and retinoic acid. It has several roles in ocular metabolism: it is essential for corneal and conjunctival epithelial cell RNA and glycoprotein synthesis,4 while retinal is the crucial chromophore which combines with both rod and cone opsins to form rhodopsin and activated cone opsins, which are essential for phototransduction.

    Case report

    A 39 year old man presented with a 6 month history of night blindness, progressing more rapidly in the past 2 weeks. Three years before he had undergone a partial gastrectomy and biliopancreatic derivation for morbid obesity (Scopinaro procedure). His mean body mass index (BMI) decreased from 50 kg/m2 to 31 kg/m2 3 years later.

    At presentation, visual acuity was 6/5 in both eyes with a spherical correction of +0.75 dioptres. Slit lamp examination and funduscopy were unremarkable in both eyes. Concentric narrowing in both …

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