Een in het oog springende verwikkeling van bariatrische heelkunde

An eye-catching complication of bariatric surgery Background: Vitamin A is essential for the visual system, immune system, and cellular differentiation. Although clinically relevant hypovitaminosis A is rare in Western countries, the risk increases with the rising incidence of bariatric surgery. In the long term, these procedures can lead to deficiencies of fat-soluble vitamins, with potentially severe consequences for ocular function. Case: A 60-year-old man presented with progressive visual decline, nyctalopia, and epiphora for 2 years. He had undergone bariatric surgery (Scopinaro procedure) 21 years earlier with inadequate vitamin supplementation thereafter. Ophthalmological examination revealed Bitot spots on the conjunctiva, severe dry keratopathy, and yellowish-white macular deposits. Laboratory findings confirmed severe vitamin A deficiency (43 µg/L, reference value 300-800 µg/L), as well as vitamin D and E deficiencies. Treatment with 25,000 IU of retinol daily resulted in significant improvement in night vision and ocular dryness within one week, with complete restoration of visual acuity in the non-amblyopic eye. After six months, the Bitot spots had diminished; the macular deposits remained unchanged. Conclusion: The case emphasizes the importance of lifelong multidisciplinary follow-up for bariatric patients, with the general practitioner playing a central role in coordinating care. Timely recognition of warning signs such as visual loss, night blindness, therapy-resistant dry eyes and Bitot spots in high-risk patients can prevent permanent damage through early treatment.