京都大学 / 新制・課程博士 / 博士(医学) / 甲第24498号 / 医博第4940号 / 新制||医||1064(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 中本 裕士, 教授 森本 尚樹, 教授 大森 孝一 / 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

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

Diabetic retinopathy (DR) and diabetic macular edema (DME) are among the leading causes of vision loss worldwide. Early detection and timely intervention are crucial in decreasing the risk of vision impairment worldwide. Optical Coherence Tomography Angiography (OCTA) is an emerging imaging modality that has advantages to the current standard for assessing retinal microvascular changes in diabetic eye diseases. This study aims to evaluate the cost-effectiveness of different screening strategies incorporating OCTA for the detection and management of DR and DME. A decision tree model (Figure 2) was created to estimate the cost consequences of different screening strategies for clinically significant macular edema (CSME) and severe DR in the United States. The model can be used to compare two screening arms: A) standard fluorescein angiography (FA) and optical coherence tomography (OCT) scans with standard of care follow-up.; and B) Universal OCTA imaging with FA and OCT scans with standard of care follow-up. In both strategies, screening will start with the most sensitive imaging (OCTA > OCT > FA) that is available. Strategy A will serve as the control with the current standard image screening protocol for DME and DR diagnosis, which is based on the National Institute of Clinical Excellence (NICE) guidelines used in both the U.S. and U.K. These guidelines include FA imaging and a visual acuity test within 3 months of diagnosis of diabetes. In accordance with the guidelines, if DR or CSME is identified the participant will subsequently be referred to an ophthalmologist at which point OCT will also be obtained at this visit. If no DR or CSME is identified during imaging, the guidelines state that follow-up imaging should be conducted every 6 months. Strategy B will involve universal OCTA Imaging, FA imaging, OCT scans and a visual acuity test. Screening with OCTA imaging should be conducted before proceeding to screen the FA images taken. If criteria for CSME or severe DR is met, then the participant will be referred to an ophthalmologist. If criteria for CSME or severe DR is not met, then the participant will receive follow up imaging every 6 months.

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

Background: The relevance of drusen-like deposits (DLD) in patients with systemic lupus erythematosus (SLE) is to a large extent uncertain. Their genesis is proposed to be correlated to immune-complex and complement depositions in the framework of SLE. The intention of this study was to determine potential morphological differences in the choroid and retina as well as potential microvascular changes comparing two cohorts of SLE patients divergent in the presence or absence of DLD using multimodal imaging. Methods: Both eyes of 16 SLE patients with DLD were compared to an age- and sex-matched control-group consisting of 16 SLE patients without detectable DLD. Both cohorts were treated with hydroxychloroquine (HCQ) and did not differ in the treatment duration or dosage. Using spectral-domain optical coherence tomography (SD-OCT) choroidal volume measures, choroidal vascularity indices (CVI) and retinal layer segmentation was performed and compared. In addition, by the exploitation of optical coherence tomography angiography vascular density, perfusion density of superficial and deep retinal capillary plexuses and the choriocapillaris were analyzed. For the choroidal OCT-scans, a subset of 51 healthy individuals served as a reference-group. Results: CVI measures revealed a significant reduction in eyes with DLD compared to healthy controls (0.56 (0.54−0.59) versus 0.58 (0.57−0.59) (p = 0.018) and 0.56 (0.54−0.58) versus 0.58 (0.57−0.60) (p < 0.001)). The photoreceptor cell layer presented significant thinning in both eyes of subjects with DLD compared to control subjects without DLD (68.8 ± 7.7 µm vs. 77.1 ± 7.3 µm for right eyes, p = 0.008, and 66.5 ± 10.5 µm vs. 76.1 ± 6.3 µm for left eyes, p = 0.011). OCTA scans revealed no significant changes, yet there could be observed numerically lower values in the capillary plexuses of the retina in eyes with DLD than in eyes without DLD. Conclusions: Our results illustrated significant alterations in the choroidal and retinal analyzes, suggesting a correlation between DLD and the progression of inflammatory processes in the course of SLE leading to retinal degeneration. For this reason, DLD could serve as a biomarker for a more active state of disease.