La drépanocytose ou anémie falciforme est la maladie génétique la plus répandue dans le monde. Elle affecte plus particulièrement les populations des régions africaines sub-sahariennes, du sous-continent Indien et celles issues de ces populations. La Guadeloupe, archipel des Antilles françaises est une zone à forte prévalence drépanocytaire. La drépanocytose se caractérise par des anomalies de l’hémoglobine et du globule rouge qui mènent à des complications aigues et chroniques pouvant toucher tous les organes, dont les yeux. Récemment, plusieurs auteurs ont rapporté une prévalence importante de la maculopathie dans la drépanocytose mais la physiopathologie reste très mal comprise. Ainsi, nous avons réalisé deux études. La première, consistait à étudier la prévalence de la rétinopathie et de la maculopathie drépanocytaires et de tester l’association entre ces deux complications. De plus, nous avons recherché un éventuel lien avec différentes anomalies biologiques. Nous avons montré que la rétinopathie et la maculopathie étaient deux complications fréquentes mais indépendantes dans la drépanocytose. Les résultats de cette première étude ne supportent pas un lien éventuel entre les anomalies hématologiques, hémorhéocarlogiques ou le génotype et ces deux complications. Dans une deuxième étude nous avons essayé de mieux caractériser la maculopathie drépanocytaire en réalisant un électrorétinogramme multifocal (mfERG) et une tomographie en cohérence optique spectral domain (SD-OCT) chez des patients SS et SC sans signe clinique de maculopathie. Nous avons pu mettre en évidence des altérations maculaires électrophysiologiques chez les patients drépanocytaires paraissant exempt de toute maculopathie à l’examen clinique. Par ailleurs, nous avons retrouvé que la maculopathie drépanocytaire est aussi fréquente chez les SS que chez les SC.Notre travail confirme le caractère fréquent des complications rétiniennes drépanocytaires. Cependant, elles apparaissent comme complètement indépendantes l’une de l’autre et les mécanismes physiopathologiques sous-jacents restent mal compris / Sickle cell disease (SCD) also known as sickle cell anemia is the most common genetic affection in the world. Most of SCD cases occur in sub-Saharan Africa, india and among people of African and indian descent living in other parts of the world. SCD is common in Guadeloupe, French West indies. It results in an abnormal hemoglobin leading to rigid sickle like shape red blood cells responsible for a great number of acute and chronical systemic complications including ophthalmic affections. Recently, a wild prevalence of maculopathy has been reported by several authors but its pathophysiology remains unclear.We performed two studies. The aim of the first one was to investigate the prevalence of SCD retinopathy and maculopathy and to test the association between these two conditions. Moreover, we looked for a possible link with biological abnormalities. Our study confirmed that SCD maculopathy and retinopathy are common but they remain two independent affections. Nevertheless, we found no association with hematological parameters, blood rheology of genetic.In the second study, we described and compared spectral domain ocular coherence tomography (SD-OCT) and multifocal electroretinogram (mfERG) findings in patients with SCD without clinical sign of maculopathy, according to the hemoglobin genotype. We found electrophysiological macular dysfunction in SCD patients with no clinical maculopathy. Furthermore, maculopathy was as frequent in SCA than in SCC patients.Our work confirms that retinal affections are common in SCD. Nevertheless, retinopathy and maculopathy seem to be two independent complications and their pathophysiology remains misunderstood.

Die Frühgeborenenretinopathie (Retinopathia praematurorum (RPM)) ist eine Erkrankung der Netzhaut, die vor allem sehr unreife Frühgeborene betrifft und in ihrem Endstadium zur Erblindung führen kann. Ein gesicherter Risikofaktor für die Entwicklung einer RPM ist die Gabe von hohen Konzentrationen an Sauerstoff nach der Geburt. Gegenstand dieser Arbeit war die Frage, ob nach der Einführung eines Sauerstoffprotokolls 2007 das Auftreten höherer Stadien der RPM reduziert werden konnte. Das Sauerstoffprotokoll hatte zum Ziel die Gabe von inspiratorischem Sauerstoff nach Möglichkeit zu senken und übermäßige Fluktuationen zu vermeiden. Hierfür wurden 268 Frühgeborene mit einem Gestationsalter < 32Wochen bei Geburt, welche in den Jahren von 2005 bis 2006 (pre-Gruppe) und 2008 bis 2009 (post-Gruppe) in der Universitätsklinik Leipzig geboren und einem RPM-Screening unterzogen wurden, verglichen. Es konnte gezeigt werden, dass die Inzidenz der RPM nach 2007 signifikant niedriger war. So erkrankten in der pre-Gruppe 12 von 102 Kinder an einer höhergradigen RPM (>Stadium 3), wohingegen diese Stadien in der post-Gruppe nicht mehr beobachtet wurden. Demzufolge reduzierte sich auch die Notwendigkeit einer Therapie von 7,4 % auf 0 % (jeweils p = 0.0005). In Hinblick auf die Kerndaten wie Gestationsalter, Geburtsgewicht, Körpergröße, sowie dem Auftreten schwerer Begleiterkrankungen wie u.a. der nekrotisierenden Enterokolitis oder der bronchopulmonalen Dysplasie fanden sich keine Unterschiede zwischen den Gruppen. Allerdings wies die post-Gruppe eine höheren Anteil an männlichen Frühgeborenen auf. Die Mortalität zeigte keine signifikante Veränderung nach der Intervention und lag bei 7.8 % in der pre- bzw. 6.6 % in der post-Gruppe (p = 0.81). Die Auswertung der pulsoximetrisch gemessenen Sauerstoffsättigung (SpO2) und der inspiratorischen Sauerstofffraktion (FiO2) zeigte, dass der SpO2 leicht und der FiO2 deutlich reduziert werden konnte. Ein signifikanter Unterschied ergab sich hier jedoch lediglich für den FiO2, insbesondere in den ersten 14 Lebenstagen. Die logistische Regressionsanalyse legt nahe, dass hohe SpO2- und FiO2-Werte sowie das Auftreten von intrakraniellen Blutungen mit schwerwiegenden ROP-Stadien korrelieren. Ein bedachter Umgang in der Sauerstofftherapie Frühgeborenen könnte in der Lage sein das Auftreten der Frühgeborenenretinopathie zu reduzieren ohne eine Erhöhung der Mortalitätsrate zu riskieren.

Purpose The aim of this study was to audit the knowledge and practices regarding eye care and eye complications of diabetes mellitus (DM) among diabetic patients 18 years and above in Kampala, Uganda. Methods. A cross-sectional study was done to collect data on the demographics, level of awareness and practices of the 409 diabetic patients regarding eye care and eye complications of DM. Data collected was captured in EPIDATA version 3.1, exported to STATA version 15.0 for further management and analysis. Participants characteristics were summarized using summary statistics and graphs. Using a standard questionnaire, scores for knowledge and practice for diabetes; knowledge and practice on diabetic retinopathy were generated and in all the four scores aforesaid, participants were classified as having good or poor knowledge and practice1. Proportions of participants demonstrating good awareness and good practice were reported. Fishers and Pearson chi- square tests were used to test for associations between patient’s characteristics and knowledge and practice on DM. Bivariable and logistic regression analysis was performed and variables with a p-value of < 0.2 of the unadjusted odds ratio were further analyzed at multivariate logistic regression analysis to find out factors that significantly predict patient’s knowledge and practice on diabetes mellitus. Results. A total of 409 participants were interviewed in the study, majority were females 293 (71.6%) and mean age (SD) was 50 (12) years. A high proportion of participants 314 (76.9%) was aware that DM could affect the eyes but only 24 (5.9%) stated diabetic retinopathy as an eye complication in diabetic patients. Good knowledge about diabetes mellitus was demonstrated by 178 (43.5%) of the study participants. However, only 33.3% had good knowledge on eye care and diabetic retinopathy. It was determined that female diabetic patients and those who stayed with DM for 10 years and beyond were less likely to have good practice on DM compared to male patients and those who had been with DM for less than five years (OR, 95% CI: 0.58, 0.36-0.95, P=0.029: OR, 95% CI: 0.53, 0.32-0.87, P=0.011). It was also found that diabetic patients with good knowledge of DM were at least three times more likely to have good practice compared to those with the poor knowledge (OR, 95% CI: 3.2, 2.1 -4.8, P <0.001). Conclusion Lack of knowledge regarding the importance and need for periodic eye check-up for diabetic retinopathy was a significant finding in his study. Good knowledge on diabetes, gender and duration of DM had significant association with the patients practice patterns.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21629号 / 医博第4435号 / 新制||医||1033(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 伊佐 正, 教授 柳田 素子, 教授 宮本 享 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background/Aims: This study aimed to analyze the effects of perinatal history on tear film properties and lid geometry in adults born preterm. Methods: The Gutenberg Prematurity Eye Study (GPES) is a German prospective examination of adults born preterm and term aged 18 to 52 years with Keratograph® 5M and Schirmer test I. Main outcome measures were first non-invasive tear film break-up time (F-NITBUT), bulbar redness (BR), Schirmer test, and nasal palpebral angle measurement. The associations with gestational age (GA), birth weight (BW), and BW percentile, retinopathy of prematurity (ROP), ROP treatment, and other perinatal factors were evaluated using regression analyses. Results: 489 eyes of 255 preterm and 277 eyes of 139 full-term individuals (aged 28.6 +/− 8.8 years, 220 females) were included. Of these, 33 participants (56 eyes) had a history of spontaneously regressed ROP and 9 participants (16 eyes) had a history of ROP treatment. After adjustment for age and sex, lower F-NITBUT (<20 s) was associated with ROP treatment (OR = 4.42; p = 0.025). Lower GA correlated with increased bulbar redness (B = −0.02; p = 0.011) and increased length of wetting in the Schirmer test (B = −0.69; p = 0.003). Furthermore, low GA was associated with narrowing of the nasal palpebral angle (B = 0.22; p = 0.011) adjusted for age and sex, but not when considering ROP in the multivariable model. Conclusion: Our analyses indicate that perinatal history affects ocular surface properties, tear production and lid geometry in adults born term and preterm. This might indicate that affected persons have a predisposition to diseases of the corneal surface such as the dry eye disease.

Bakgrund: Ögonsjuksköterskor möter många patienter med diabetesretinopati, vilkakan vara utmanande för ögonsjuksköterskorna då det förekommer att patienter saknar sjukdomsinsikt. Det leder till svårigheter att få patienten delaktig i sin vård, men även att ge tillräckligt med information då patienten även kan vara orolig vid dessa möten. Syfte: Syftet med studien var att undersöka ögonsjuksköterskors upplevelser av att informera patienter med diabetesretinopati. Metod: En kvalitativ studie med semistrukturerade intervjuer användes där totalt sju ögonsjuksköterskor från Västra Götalandsregionen och Region Halland deltog. Resultat: Analysen resulterade i två huvudkategorier Bygga en relation och Behov av kunskap. De fem subkategorierna var Ögonsjuksköterskans roll, Patienternas delaktighet, Brist på sjukdomsinsikt, Patienternas oro och rädsla samt Vikten av information. Konklusion: Resultatet visade att ögonsjuksköterskorna upplevde att det är av vikt att informera och även få patienten delaktig i sin vård då patienternauttrycker en rädsla och oro. Studien kan vara ett stöd för ögonsjuksköterskorna infördessa möten och vidareutveckla dem både utifrån ett sjuksköterske- och patientperspektiv. I vidare forskning vore det av intresse att få en fördjupad kunskap om patienternas upplevelser av ögonbottenfotografering samt information i samband med den. / Background: Ophthalmic nurses meet many patients with diabetic retinopathy. These meetings can be challenging for the ophthalmic nurses as some patients lack insight about the disease, which makes it difficult to get the patient involved and provide enough information as the patient may also be worried at these meetings. Aim: The aim of the study was to investigate ophthalmic nurses’ experiences of informing patients with diabetic retinopathy. Method: A qualitative study with semi-structured interviews was used where seven ophthalmic nurses from Västra Götaland Countyand the Halland County participated. Results: The analysis resulted in two main categories Building a Relationship and Need for Knowledge and five subcategories; The Ophthalmic Nurse's role, Patient participation, Lack of disease insight, Patients' anxiety and fear and The importanceof information. Conclusion: The results showed that the ophthalmic nurses felt that it was important to inform and also get the patient involved in their care as the patients express fear and anxiety. The study can be a support for the ophthalmic nurses in these meetings and further develop them from both a nurse and patient perspective. In further research, it would be of interest to gain an in-depth knowledge of patients´ experiences of fundus photography and the information they receive.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24877号 / 医博第5011号 / 新制||医||1068(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 川上 浩司, 教授 森田 智視, 教授 長船 健二 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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