Thesis (doctoral)--Lund University, 1998. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Thesis (doctoral)--Lund University, 1998. / Added t.p. with thesis statement inserted. Includes bibliographical references.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22119号 / 医博第4532号 / 新制||医||1039(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 大森 孝一, 教授 Shohab YOUSSEFIAN, 教授 山下 潤 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

PURPOSE: This study aims to quantify the retinal vascular blood flow in eyes affected by unilateral central retinal vein occlusions (CRVO) or branch retinal vein occlusions (BRVO). We created and explored a new, unitless metric for the severity of these diseases: relative blood flow (RBF). We then contextualized RBF in terms of patient demographics, ocular presentation and other systemic conditions, as well as explored its efficacy as a predictor of future outcomes. METHODS: Data was collected from 20 control subjects and 32 patients with clinically diagnosed retinal vein occlusions (15 CRVO and 17 BRVO). Laser speckle flowgraphy was then used to quantify retinal vascular blood flow in terms of mean blur rate, a metric shown to be highly heterogeneous between patients but fairly consistent in intra-patient repeated measurements over time. After confirming this and establishing a strong correlation between a healthy patient’s two eyes, we used an RVO patient’s fellow eye as a nondiseased expectation and presented relative blood flow as the ratio between their diseased and healthy eye. We then correlated this data with demographic variables and disease characteristics from patients’ medical history. RESULTS: We found an average blood flow decrease of 26% in CRVO eyes relative to healthy eyes in the same patients and an average decrease of 7% in BRVO eyes. In CRVO, duration of occlusion, central macular thickness, intraocular pressure, diabetes, previous laser and injection treatments, and an injection within three months after blood flow measurement were significantly associated with relative blood flow. In BRVO, no demographic variables or disease characteristics were significantly associated with relative blood flow. CONCLUSIONS: Relative blood flow represents a promising new, consistent and informative metric for quantifying the severity of unilateral retinal vein occlusions. With both descriptive and predictive properties in eyes with CRVO, future work should explore its great potential.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12917号 / 論医博第2092号 / 新制||医||1009(附属図書館) / 32127 / 京都大学大学院医学研究科医学専攻 / (主査)教授 河野 憲二, 教授 大森 治紀, 教授 渡邉 大 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

PURPOSE: Retinal and choroidal ischemic retinopathies such as retinal-vein occlusion (RVO), diabetic retinopathy (DR), and age-related macular degeneration (AMD) are ocular diseases caused by abnormal changes in the microvasculature. The ischemia can lead to macular edema or neovascularization, which can affect vision. Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) can help to reduce macular edema and improve visual acuity. Lost to follow-up (LTFU) after anti-VEGF injections increases the risk of vision loss in patients with RVO, DR, and AMD. METHODS: Patients scheduled for an IVI of anti-VEGF between September 2009 and September 2019 with either RVO, DR, or AMD were included in the analysis. LTFU was defined as missing an appointment without another evaluation for at least one interval exceeding 180 days. All patients were seen by a single provider at an urban, hospital-based, single-site retina practice in Boston, MA. RESULTS: Among the 698 patients (mean [SD] age, 70.23 [14.2] years; 373 [53.4%] female) identified as receiving an IVI, 121 (17.3%) were LTFU. Age was not found to be statistically different between the LTFU and not LTFU groups (mean difference, -1.67; 95% CI, -4.66¬–1.32; P=.27). Odds of LTFU was lower among patients with AMD (odds ratio [OR], 0.57; 95% CI, 0.36-0.92; P=.02). Odds of LTFU was greater among patients with Medicaid insurance (OR, 2.31; 95% CI, 1.22-4.33; P=.01), compared with patients with Medicare insurance. A trend towards higher risk of LTFU was seen in patients with DR (OR, 1.42; 95% CI, 0.94-2.15; P=.09) and a toward lower risk in patients with two or more eye diseases (OR, 0.53; 95% CI, 0.24-1.15; P=.10). Medicaid insurance was the only significant (P=.02) independent risk factor of LTFU in the multivariate regression. CONCLUSION: We found a high rate of LTFU after anti-VEGF injections among patients with RVO, DR, AMD, and identified risk and protective factors associated with LTFU among this population. Although our results may not be generalizable, data on LTFU in a clinical practice setting are needed to understand the scope of the problem so that interventions may be designed to improve outcomes.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20986号 / 医博第4332号 / 新制||医||1027(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 富樫 かおり, 教授 羽賀 博典, 教授 別所 和久 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20996号 / 医博第4342号 / 新制||医||1027(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 鈴木 茂彦, 教授 富樫 かおり, 教授 開 祐司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Retinale Venenverschlüsse sind eine der häufigsten vaskulären Netzhauterkrankungen. Bei der Entstehung und dem Verlauf von venösen Gefäßverschlüssen im Auge spielen kardiovaskuläre Risikofaktoren eine entscheidende Rolle. Patienten mit einem retinalen Venenverschluss weisen vermehrt vaskuläre Risikofaktoren für arterielle Gefäßkrankheiten auf, weswegen es von hoher klinischer Relevanz ist, diese frühzeitig zu erkennen und zu behandeln. Bisher gibt es kein einheitliches Untersuchungsschema zur Ursachenabklärung eines retinalen Venenverschlusses. Ziel ist es, Empfehlungen einer zukünftigen Routinediagnostik für venöse Gefäßverschlüsse im Auge auszusprechen. In der FIND-AF-EYE-Studie wurde erstmals durch eine umfangreiche Diagnostik an insgesamt 101 Patienten mit retinalen Gefäßverschlüssen eine systematische Abklärung kardiovaskulärer Risikofaktoren kontrolliert durchgeführt. Die Diagnostik umfasste eine duplexsonographische Untersuchung der A. carotis, eine Echokardiographie, eine 24 h-Blutdruckmessung, ein 7 d-LZ-EKG und eine laborchemische Erhebung des Lipid- und Glukosestatus. Bei der Auswertung der 41 Patienten mit venösen Gefäßverschlüssen im Auge konnte wie auch in vergleichbaren Studien gezeigt werden, dass vor allem die arterielle Hypertonie, der Nikotinkonsum, die Hyperlipidämie und der Diabetes mellitus die wichtigsten kardiovaskulären Risikofaktoren darstellen. Zudem wurde durch die verlängerte elektrokardiographische Aufzeichnungsdauer über sieben Tage mehr als ein Drittel aller Patienten mit Herzrhythmusstörungen identifiziert. Anhand der Ergebnisse der vorliegenden Studie sind apparative Untersuchungen wie eine 24 h-Blutdruckmessung, eine Echokardiographie und ein 7-Tage-Langzeit-EKG unverzichtbar. Laborchemisch sollten ein Lipidstatus und ein Blutzuckerprofil routinemäßig erhoben werden. Zur Einschätzung des kardiovaskulären Risikos des Patienten erscheint eine Untersuchung der A. carotis sinnvoll. Um die Morbidität und die Mortalität zu senken bedarf es einer interdisziplinären Ursachenabklärung, welches die enge Zusammenarbeit zwischen Ophthalmologen und Internisten erfordert. Vergleicht man die FIND-AF-EYE-Studie mit der bereits publizierten FIND-AF-Studie litten die Patienten der FIND-AF-Studie signifikant häufiger an einer Karotisstenose. Zusammenfassend lässt sich sagen, dass akuten arteriellen Verschlüssen, wie beispielsweise einer zerebralen Ischämie, in den meisten Fällen thromboembolische Ereignisse zugrunde liegen. Kardiovaskuläre Risikofaktoren spielen aber auch bei venösen Gefäßverschlüssen im Auge eine wichtige Rolle. Hierbei führen sie zu arteriosklerotischen Veränderungen der eng benachbarten Zentralarterie. Durch die Kompression kommt es somit zur Thrombenbildung in der Zentralvene.

Avaliou-se a prevalência de hipertensão arterial sistêmica (HAS) e a variação circadiana da pressão arterial (PA), através da Monitorização ambulatorial da pressão arterial (MAPA), em pacientes com oclusão do ramo da veia central da retina (ORVCR). Foram avaliados, prospectivamente, 93 casos/olhos de 83 pacientes. A ausência do descenso fisiológico da PA durante o sono ("non-dipper") foi definida como diminuição da pressão sistólica = 10% e a presença de descenso quando este valor fosse maior ("dipper"). Há uma prevalência extremamente alta (94%) de HAS em pacientes com ORVCR. Entre os hipertensos, uma grande parcela dos indivíduos "non-dipper" (n=34; 44,2%). Estas evidências sugerem que um nível mais sustentado de PA nas 24 horas possa ser um fator de risco para o desenvolvimento da ORVCR / Objective: Identifying with Blood pressure monitoring (BPM) in patients with branch retinal vein occlusion (BRVO): high blood pressure (HBP) prevalence, possible cases of white-coat normotension (WCNT) and variation of circadian blood pressure (BP). Methods: Prospectively, 93 cases/eyes of 83 patients with BRVO were evaluated at Ophthalmological Clinic of "Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo" (HCFMUSP). After that, patients were taken to Hypertension League of Nephrology Chair of HCFMUSP (LH-HCFMUSP) for clinical evaluation and blood pressure monitoring. Non-dipper was defined as a fall in systolic blood pressure = 10%, and dipper when this value was higher