Early Intraocular Pressure Changes After Laparoscopic Sleeve Gastrectomy: A Prospective Comparative Study

Obesity is a serious health problem worldwide and is associated with several ocular conditions, including glaucoma, cataract, and age-related macular degeneration. Elevated intraocular pressure (IOP) is a well-established and modifiable risk factor for glaucomatous optic neuropathy. This study aimed to evaluate early changes in IOP following laparoscopic sleeve gastrectomy and to examine their relationship with weight loss. A secondary exploratory aim was to describe whether postoperative improvement in hypertension or diabetes mellitus was accompanied by additional changes in IOP.

This prospective comparative study included 82 patients who underwent laparoscopic sleeve gastrectomy between 2024 and 2025 and completed the predefined 6-month follow-up, together with 82 prospectively enrolled age- and sex-comparable non-obese control participants serving as a reference cohort. The control cohort was used to contextualize IOP values in non-obese individuals and was not designed to isolate the independent effects of surgical stress, weight loss, or metabolic improvement. Ophthalmologic evaluations, including IOP measurement, were performed at baseline and at 6 months according to the study protocol, whereas systemic comorbidity outcomes were ascertained from routine clinical follow-up records at 6 months. For correlation analyses, right- and left-eye IOP values were evaluated separately, whereas mean IOP values were used for patient-level analyses. Changes in IOP were assessed before and after surgery, and correlations between changes in body mass index (BMI) and IOP were examined. Subgroup observations according to postoperative improvement in hypertension and diabetes mellitus were considered exploratory.

The mean age was 37.4 ± 9.2 years in the sleeve gastrectomy group and 39.6 ± 9.6 years in the control group. The surgical group included 36 men and 46 women, and the control group included 43 men and 39 women. No significant differences were observed between the groups in age or sex distribution. Six months after surgery, BMI and body weight decreased significantly (both p < 0.001). Mean IOP decreased significantly after sleeve gastrectomy, with a mean change of approximately - 3.0 mmHg (p < 0.001). Baseline mean IOP was significantly higher in the sleeve gastrectomy group than in controls (p = 0.012). At 6 months, mean IOP in the sleeve gastrectomy group had decreased to 12.8 ± 2.2 mmHg compared with 13.3 ± 3.5 mmHg in controls (p = 0.038). Significant positive correlations were observed between reductions in BMI and decreases in IOP in both the right eye (r = 0.545, p < 0.001) and left eye (r = 0.489, p < 0.001). Exploratory subgroup observations suggested a greater IOP reduction in patients with postoperative improvement in hypertension, whereas improvement in diabetes mellitus did not appear to confer an additional short-term effect.

Laparoscopic sleeve gastrectomy was associated with a significant short-term reduction in intraocular pressure in obese patients, and greater BMI reduction was associated with greater IOP reduction. Postoperative improvement in hypertension may also be associated with a greater decrease in IOP; however, this finding should be interpreted cautiously because the subgroup observations were exploratory. Larger prospective controlled studies are needed to clarify the independent contributions of weight loss, metabolic improvement, and surgery-related factors.