Prevalence of pinguecula and pterygium in a general population in Spain

Clinical Applications of Anterior Segment Optical Coherence Tomography: An Updated Review

Since its introduction, optical coherence tomography (OCT) has revolutionized the field of ophthalmology and has now become an indispensable, noninvasive tool in daily practice. Most ophthalmologists are familiar with its use in the assessment and monitoring of retinal and optic nerve diseases. However, it also has important applications in the assessment of anterior segment structures, including the cornea, conjunctiva, sclera, anterior chamber, and iris, and has the potential to transform the clinical examination of these structures. In this review, we aim to provide a comprehensive overview of the potential clinical utility of anterior segment OCT (AS-OCT) for a wide range of anterior segment pathologies, such as conjunctival neoplasia, pterygium, scleritis, keratoconus, corneal dystrophies, and infectious/noninfectious keratitis. In addition, the clinical applications of AS-OCT (including epithelial mapping) in preoperative planning and postoperative monitoring for corneal and refractive surgeries are discussed.

[Current possibilities for the diagnosis and treatment of pterygium]

Pterygium is a common inflammatory-proliferative disease characterized by the invasion of degeneratively altered fibrovascular tissue into the cornea. This literature review analyzes the etiological factors and pathogenetic concepts of its development, describes modern methods of diagnostics and surgical treatment of pterygium, and pays particular attention to the assessment of structural and functional changes in the cornea occurring during the growth of pterygium and after its excision.

Sensory Changes in the Ocular Surface After Pterygium Removal

Purpose

We measure changes in ocular surface sensation after pterygium surgery with a conjunctival autograft.

Methods

This prospective, interventional study was carried out in patients, with nasal primary pterygium undergoing pterygium surgery with conjunctival autograft. Sensation was measured by applying the tip of the Cochet-Bonnet esthesiometer filament perpendicular to the ocular surface in the cornea and conjunctiva. Patients were tested preoperatively (baseline), and at 2 weeks, 2 and 4 months, postoperatively.

Results

Nineteen eyes of 18 patients completed the 4-month follow-up. Mean age was 61±10.1 (range 36-76) years. Corneal sensation returned to normal values in all at 2 and at 4 months. The central cornea was significantly more sensitive compared to the average of the four peripheral measurements pre- (59.2 mm vs 48.3 mm, p=0.000) and postoperatively (59.2 mm vs 48.4 mm, p=0.000). Conjunctival sensation was reduced significantly 2 months postoperatively in the inferior region (p=0.04). Four months postoperatively, it was more sensitive in the superior area (13.9 mm vs 17.1 mm, p=0.01) and the inferior area (13.7 mm vs 19.5 mm, p=0.003). In each matching area, the cornea was significantly more sensitive than the conjunctiva pre- and postoperatively (p=0.00). Sensation was not significantly different between the sexes or age groups.

Conclusion

This study demonstrates the presence of inferior and superior conjunctival hyperesthesia at conjunctival autograft sites after pterygium surgery. The healing process, sensory input, tear film instability and epitheliopathy of the ocular surface are possible explanations for these novel findings.

TFOS Lifestyle Report: Impact of environmental conditions on the ocular surface

Environmental risk factors that have an impact on the ocular surface were reviewed and associations with age and sex, race/ethnicity, geographical area, seasonality, prevalence and possible interactions between risk factors are reviewed. Environmental factors can be (a) climate-related: temperature, humidity, wind speed, altitude, dew point, ultraviolet light, and allergen or (b) outdoor and indoor pollution: gases, particulate matter, and other sources of airborne pollutants. Temperature affects ocular surface homeostasis directly and indirectly, precipitating ocular surface diseases and/or symptoms, including trachoma. Humidity is negatively associated with dry eye disease. There is little data on wind speed and dewpoint. High altitude and ultraviolet light exposure are associated with pterygium, ocular surface degenerations and neoplastic disease. Pollution is associated with dry eye disease and conjunctivitis. Primary Sjögren syndrome is associated with exposure to chemical solvents. Living within a potential zone of active volcanic eruption is associated with eye irritation. Indoor pollution, "sick" building or house can also be associated with eye irritation. Most ocular surface conditions are multifactorial, and several environmental factors may contribute to specific diseases. A systematic review was conducted to answer the following research question: "What are the associations between outdoor environment pollution and signs or symptoms of dry eye disease in humans?" Dry eye disease is associated with air pollution (from NO2) and soil pollution (from chromium), but not from air pollution from CO or PM10. Future research should adequately account for confounders, follow up over time, and report results separately for ocular surface findings, including signs and symptoms.

Facial dermatosis papulosa nigra, a risk for the development of pterygium and myopia: a descriptive cross-sectional study in Ghana

Background. Dermatosis papulosa nigra (DPN) affects sun-exposed areas such as the face, neck, and trunk. The prevalence of pterygium and myopia in DPN patients in Ghana has not been studied. In this study, we examined the risk and protective factors for pterygium and myopia in DPN patients. Materials and Methods. The study involved 100 participants with facial DPN. A standard ophthalmic exam was performed using a portable slit lamp and a 3.5X magnified loop. Participants completed a closed- ended questionnaire. Logistic regression was used to summarize the level of association between DPN, myopia, and pterygium, as well as demographic factors (gender, age, occupation, family history of lesion and skin complexion). Results. 70% and 84% of participants had pterygium and myopia. Age, gender, complexion, and sun exposure were associated with pterygium and myopia (p < 0.05). Higher grade of pterygium and myopia were prevalent in the aged population. Both univariate and multivariable models highlighted that increasing age and sun exposure (outdoor) were risk factors for developing higher grade of pterygium and myopia in the DPN participants, while light skin color and male gender were respectively identified as protective factors. Conclusions. Our study is the first to examine pterygium and myopia in facial DPN patients. Most Ghanaians with facial DPN are at risk for developing pterygium and myopia.

The Relationship between Pinguecula and Diabetes Mellitus: A Comparative Cross-Sectional Study

Purpose

To assess the relationship between diabetes mellitus (DM) and the presence of pinguecula and to identify other risk factors associated with pinguecula in patients attending the eye clinic at two tertiary university hospitals in Jordan.

Methods

This was a comparative cross-sectional hospital-based study of 241 consecutive patients (122 patients with DM and 119 patients with no diabetes). All patients underwent complete ophthalmic examination, and data were collected regarding age, sex, occupational activity, presence and grade of pinguecula, glycosylated hemoglobin (HbA1c), and presence of diabetic retinopathy.

Results

The mean (standard deviation, SD) ages of the DM and non-DM groups were 59.5 (10.8) years and 59.0 (11.6) years (p-value = 0.729), respectively. There was no significant difference in the prevalence of pinguecula between the diabetic and nondiabetic groups (66.4% vs. 66.5%, p = 0.998). Multivariate logistic regression analysis revealed that only outdoor occupational activity (OR = 5.16, 95% CI: 1.98-13.44, p = 0.001) was associated with increased prevalence of pinguecula. DM was not significantly associated with pinguecula (OR = 0.96, 95% confidence interval (CI): 0.55-1.67, p = 0.873). Neither age nor sex were significantly associated with pinguecula (p-value = 0.808, p-value = 0.390), respectively.

Conclusion

DM was not significantly associated with the development of pinguecula in this Jordanian population. The prevalence of pinguecula was significantly associated with an outdoor occupational activity.

Ocular health among industrial workers: a prevalence study of foreign body injury, refractive error, dry eye, pterygium and pingueculae

BACKGROUND

Workplaces play a critical role in developing ocular diseases, owing to the risk of accidents. This study aimed to evaluate the ocular health of industrial workers by determining the prevalence of foreign body injury, refractive error, dry eye, and pterygium/pingueculae, as well as the factors influencing these diseases.

METHODS

This study involved on-site examinations of workers from an industrial area hosting marble processing factories and metal sectors. Data such as refractive error, foreign body injury-related corneal nephelium, pterygium/pingueculae presence, and Schirmer test-assisted dry eye evaluation were all collected.

RESULTS

The average age of workers was 35.78±10.05 years, with a female-to-male ratio of 20:220. The majority of workers had completed primary school (56.3%), smoked >1 cigarette/day (57.6%), and did not use any assistive devices for bodily functions (88.3%). On average, working hours/week were 55.07±8.79, and working years were 5.99±7.00. Dry eyes were found in 31 (22%), and 35 (34%) marble and metal workers, respectively (p=0.042). 11 (7.9%) marble workers and 29 (28%) metal workers had foreign body ocular injury-related corneal nephelium (p=0.0001). Furthermore, pterygium/pingueculae were revealed in 17 marble workers (12.3%) and three metal workers (3%) (p=0.009).

CONCLUSIONS

Ocular health is essential, and routine ocular health screening in industrial workers, as well as workplace safety measures, should be implemented to prevent potential occupational accidents.

Bindehautdegenerationen und -neoplasien

Erhabenheiten der Bindehaut entstehen durch Gewebevermehrung, die entweder degenerativ oder neoplastisch, aber auch entzündlich sein können. In diesem Artikel werden degenerative (Pterygium und Pinguecula) sowie benigne und maligne neoplastische Bindehautveränderungen (epitheliale, melanozytäre und vaskuläre Tumoren, Choristome sowie Metastasen) bezüglich der Pathogenese, Symptome, Diagnostik und aktuellem Stand der Behandlung dargestellt.

[Conjunctival Degeneration and Neoplasia]

Conjunctival tumors result from gain of tissue, which can be either degenerative or neoplastic, but also inflammatory. In this article, degenerative (pterygium and pinguecula) as well as benign and malignant neoplastic conjunctival changes (epithelial, melanocytic and vascular tumors, choristomas as well as metastases) are discussed with regard to pathogenesis, symptoms, diagnostics and current status of treatment.

Regional features of the epidemiology of pterygium in the Republic of Bashkortostan

Background. Pterygium is ubiquitous and multifactorial; today, information on  the  prevalence of pterygium, risk factors, the relationship of its development with concomitant pathology and the type of life activity of patients in various regions of Russia is limited. All of the above led to the conduct of this epidemiological study in the Republic of Bashkortostan.

The aim of the study: to study the prevalence of pterygium, as well as to identify the relationship of risk factors for its development with the type of life activity and concomitant diseases in the urban and rural population of the Republic of Bashkortostan.

Methods. On the basis of the Ufa Research Institute of Eye Diseases, within the framework of the Ural Eye and Medical Study (UEMS) research project, a population study of people living in urban and rural regions of the Republic of Bashkortostan was carried out. The study involved 5899  people, including men – 43.7  % (2585  people), women – 56.3 % (3314 people), urban residents made 42.3 % (2491 people), rural – 57.7 % (3408 people).

Results. As a result of our study, pterygium was diagnosed in 138 people (204 eyes – 2.3 %) (95% CI: 2.0–2.7 %). One-way analysis showed a higher prevalence of pterygium associated (p˂0.10) with a number of systemic and ophthalmic parameters. However, according to the results of multivariate analysis, it was revealed that the prevalence of pterygium was significantly associated with older age (p = 0.006), rural area of residence (p = 0.001) and low educational level (p = 0.03).

Conclusion. The prevalence of pterygium in Republic of Bashkortostan according to the UEMS study was 2.3 %, or 23 people per 1000 population among people over 40 years old. The nature of the settlement influences the prevalence of pterygium in  the Republic of Bashkortostan. Pterygium was more common among older people among all respondents who took part in the study. In the study, pterygium was not a biomarker of general somatic diseases. 

Histopathological Rate of Ocular Surface Squamous Neoplasia in Clinically Suspected Pterygium Specimens: 10-Year Results

PURPOSE

The aim of this study was to evaluate the prevalence of histopathologically confirmed ocular surface squamous neoplasia (OSSN) in clinically diagnosed pterygium samples at a tertiary center in Northern California, over a 10-year period (2009-2019).

METHODS

A retrospective chart review of patients older than 18 years with clinically diagnosed benign pterygium requiring excision was conducted. Clinically suspected pterygia were excised using standard techniques and routinely submitted to the University of California Davis for pathologic evaluation. Demographic, clinical, surgical, and pathological information were recorded and analyzed. The prevalence rate of OSSN was calculated.

RESULTS

A total of 348 consecutive specimens were evaluated. The mean (±SD) age of the patients was 58 ± 12 years, with a near equal sex representation. A total of 57 (16%) pterygia were recurrent at initial presentation. Histopathologic results demonstrated a single case of OSSN. This patient did not have a documented history of carcinoma in other organs or any history of herpes virus, human papilloma virus, or human immunodeficiency virus infection.

CONCLUSIONS

The prevalence of histopathological OSSN in clinically suspected pterygia within our sample was approximately 0.3%. Because of shared clinical characteristics of pterygia and OSSN, a high index of suspicion and judicious use of anterior segment optical coherence tomography enable for effective preoperative diagnosis of OSSN. However, in the absence of clinical expertise or high-resolution optical coherence tomography, routine tissue pathologic examination may be warranted.

Membrane of Plasma Rich in Growth Factors in Primary Pterygium Surgery Compared to Amniotic Membrane Transplantation and Conjunctival Autograft

This prospective and comparative study aimed to compare the use of a conjunctival autograft (CAG), plasma rich in growth factors fibrin membrane (mPRGF) or amniotic membrane transplantation (AMT) in primary pterygium surgery. Patients were assigned for surgery with CAG (group A), mPRGF (group B), or AMT (group C). Pterygium recurrence, Best Corrected Visual Acuity (BCVA), graft size (measured with anterior segment optical coherence tomography (AS-OCT)), and ocular surface symptoms (visual analogue scale (VAS) and ocular surface disease index (OSDI)) were evaluated. Thirteen eyes in group A, 26 in group B, and 10 in group C were evaluated. No changes in BCVA (p > 0.05) were found. Recurrence cases for groups A, B, and C were none, two, and two, respectively, and three cases of pyogenic granulomas in group A. The horizontal/vertical graft size was lower in group B vs group A (p < 0.05) from months 1 to 12. The improvement in VAS frequency for groups A, B, and C was: 35.5%, 86.2%, and 39.1%, respectively. The OSDI scale reduction for groups A, B, and C was: 12.7%, 39.0%, and 84.1%. The use of the three surgical techniques as a graft for primary pterygium surgery was safe and effective, showing similar results. The mPRGF graft represents an autologous novel approach for pterygium surgery.

Bibliometric analysis and mapping knowledge domain of pterygium: 2000-2019

AIM

To track the knowledge structure, topics in focus, and trends in emerging research in pterygium in the past 20y.

METHODS

Base on the Web of Science Core Collection (WoSCC), studies related to pterygium in the past 20y from 2000-2019 have been included. With the help of VOSviewer software, a knowledge map was constructed and the distribution of countries, institutions, journals, and authors in the field of pterygium noted. Meanwhile, using co-citation analysis of references and co-occurrence analysis of keywords, we identified basis and hotspots, thereby obtaining an overview of this field.

RESULTS

The search retrieved 1516 publications from WoSCC on pterygium published between 2000 and 2019. In the past two decades, the annual number of publications is on the rise and fluctuated a little. Most productive institutions are from Singapore but the most prolific and active country is the United States. Journal Cornea published the most articles and Coroneo MT contributed the most publications on pterygium. From co-occurrence analysis, the keywords formed 3 clusters: 1) surgical therapeutic techniques and adjuvant of pterygium, 2) occurrence process and pathogenesis of pterygium, and 3) epidemiology, and etiology of pterygium formation. These three clusters were consistent with the clustering in co-citation analysis, in which Cluster 1 contained the most references (74 publications, 47.74%), Cluster 2 contained 53 publications, accounting for 34.19%, and Cluster 3 focused on epidemiology with 18.06% of total 155 co-citation publications.

CONCLUSION

This study demonstrates that the research of pterygium is gradually attracting the attention of scholars and researchers. The interaction between authors, institutions, and countries is lack of. Even though, the research hotspot, distribution, and research status in pterygium in this study could provide valuable information for scholars and researchers.

Pterygium: an update on pathophysiology, clinical features, and management

Pterygium is a relatively common ocular surface disease. The clinical aspects and the treatment options have been studied since many years ago, but many uncertainties still exist. The core pathologic pathway and the role of heredity in the development of pterygium are still attractive fields for the researchers. The role of pterygium in corneal irregularities, in addition to the refractive properties of pterygium removal, has been increasingly recognized through numerous studies. The association between pterygium and ocular surface neoplasia is challenging the traditional beliefs regarding the safe profile of the disease. The need for a comprehensive clinical classification system has encouraged homogenization of trials and prediction of the recurrence rate of the pterygium following surgical removal. Evolving surgical methods have been associated with some complications, whose diagnosis and management are necessary for ophthalmic surgeons. According to the review, the main risk factor of pterygium progression remains to be the ultraviolet exposure. A major part of the clinical evaluation should consist of differentiating between typical and atypical pterygia, where the latter may be associated with the risk of ocular surface neoplasia. The effect of pterygium on astigmatism and the aberrations of the cornea may evoke the need for an early removal with a purpose of reducing secondary refractive error. Among the surgical methods, conjunctival or conjunctival-limbal autografting seems to be the first choice for ophthalmic surgeons because the recurrence rate following the procedure has been reported to be lower, compared with other procedures. The use of adjuvant options is supported in the literature, where intraoperative and postoperative mitomycin C has been the adjuvant treatment of choice. The efficacy and safety of anti–vascular endothelial growth factor agents and cyclosporine have been postulated; however, their exact role in the treatment of the pterygium requires further studies.

Rapid bioprinting of conjunctival stem cell micro-constructs for subconjunctival ocular injection

Ocular surface diseases including conjunctival disorders are multifactorial progressive conditions that can severely affect vision and quality of life. In recent years, stem cell therapies based on conjunctival stem cells (CjSCs) have become a potential solution for treating ocular surface diseases. However, neither an efficient culture of CjSCs nor the development of a minimally invasive ocular surface CjSC transplantation therapy has been reported. Here, we developed a robust in vitro expansion method for primary rabbit-derived CjSCs and applied digital light processing (DLP)-based bioprinting to produce CjSC-loaded hydrogel micro-constructs for injectable delivery. Expansion medium containing small molecule cocktail generated fast dividing and highly homogenous CjSCs for more than 10 passages in feeder-free culture. Bioprinted hydrogel micro-constructs with tunable mechanical properties enabled the 3D culture of CjSCs while supporting viability, stem cell phenotype, and differentiation potency into conjunctival goblet cells. These hydrogel micro-constructs were well-suited for scalable dynamic suspension culture of CjSCs and were successfully delivered to the bulbar conjunctival epithelium via minimally invasive subconjunctival injection. This work integrates novel cell culture strategies with bioprinting to develop a clinically relevant injectable-delivery approach for CjSCs towards the stem cell therapies for the treatment of ocular surface diseases.

Prevalence of pterygium and its associated factors among adults aged 18 years and above in Gambella town, Southwest Ethiopia, May 2019

INTRODUCTION

A pterygium is a wing-shaped fibro-vascular growth of conjunctiva on the superficial cornea/conjunctiva. It is an elastotic degeneration of conjunctival stroma mainly due to Ultraviolet light exposure. The prevalence of pterygium varies in different environmental conditions. Its magnitude varies widely from 1.1% to 53% globally and in Ethiopia, it reaches from 8.8% to 38.7%.

OBJECTIVE

To determine the prevalence of pterygium and its associated factors among adults aged 18 years and above in Gambella town, Southwest Ethiopia, 2019.

METHODS AND MATERIALS

A community based cross-sectional study was conducted from April 15 to May 3, 2019, in Gambella town. A total of 402 study participants were selected using a systematic random sampling technique. A pre-tested semi-structured questionnaire, torch, and magnifying loops were used to collect data. The data was entered into epidemiological information 7.1 and exported to statistical package for social science version 20 for analysis. The binary and multivariate logistic regression analysis model was fitted to identify factors associated with pterygium. Odds ratio with respected 95% CI was used to identify the direction and strength of association.

RESULTS

A total of 400 participants were examined with a response rate of 99.50%. The mean age of the study participants was 39.9±9.8years. The prevalence of pterygium among adults aged 18 years and above in Gambella town was 127(31.80%), (95% CI: 27.3, 36.3). male sex (AOR = 2.10 (95% CI: 1.26, 3.45), sunlight exposure (AOR = 6.86 (95% CI: 4.00, 11.79) and outdoor works (AOR = 2.10 (95% CI: 1.21, 3.60) were positively associated with pterygium whereas wearing sunglass/hat was a protective factor.

CONCLUSION

The prevalence of pterygium was high among adults living in Gambella town. Wearing sunglass/hat and reducing exposure time to the sun was important to reduce the development of pterygium in adults.

Fifteen-year incidence rate and risk factors of pterygium in the Southern Indian state of Andhra Pradesh

PURPOSE

To report 15-year incidence rate and associated risk factors of pterygium among people aged 30 years and above at baseline in the rural clusters of longitudinal Andhra Pradesh Eye Disease Study (APEDS III).

METHODS

The baseline APEDS I included 7771 participants of which 6447 (83%) were traced and 5395 (83.7%) were re-examined in APEDS III. To estimate the incidence of pterygium, we selected participants who were 30 years and above at baseline (4188), of which 2976 were traced and 2627 (88.3%) were examined, and based on inclusion criteria, 2290 participants were included in the study. The incidence rate of pterygium was defined as the proportion of people free of pterygium at baseline who had developed the condition at 15-year follow-up (range 13-17 years). Univariate and multivariable analyses for risk factors were undertaken.

RESULTS

The sex-adjusted incidence rate of pterygium was 25.2 per 100 person-years (95% CI 24.8 to 25.7) which was significantly higher for men than women (26.3 per 100 person-years (95% CI 25.6 to 27.0) and 24.7 (95% CI 24.1 to 25.3) respectively). At the multivariable analysis, male gender (RR: 1.35, 95% CI 1.0 to 1.83), no formal education (RR: 2.46, 95% CI 1.22 to 4.93), outdoor occupation (RR: 1.47, 95% CI 1.14 to 1.9) and lower body mass index (BMI) (<18.5) (RR: 1.25, 95% CI 1.02 to 1.55) were associated with increased risk of pterygium.

CONCLUSIONS

The overall incidence rate of pterygium was high in this rural population, especially in men and those engaged in outdoor activities, lack of formal education and with lower BMI. It is likely that greater exposure to ultraviolet light is a major contributing factor, thus warranting preventive strategies.

Relationship Between Contact Lens and Pinguecula

PURPOSE

To investigate the effects of contact lens (CL) on the frequency of pinguecula, and the relationship between dry eye disease and pinguecula.

METHODS

Two hundred and 33 cases of soft CL wearers and 230 age-matched nonwearers were enrolled in the study. Schirmer I test (ST) scores and tear break-up time (TBUT) were determined in all participants. A questionnaire including ocular surface disease index (OSDI), age, sex, and duration of CL wear was implemented to the participants before the examination.

RESULTS

The prevalence of pinguecula was 27.8% (n: 65) in the CL group and 26.5% (n: 61) in the control group. There was no significant difference between the groups (P=0.841). The prevalence of pinguecula increased with age in both groups. There was no significant difference in the prevalence of pinguecula when users were divided into three groups according to the duration of CL wear (P=0.575). The TBUT scores were lower, and the OSDI scores were higher in the CL group. The TBUT scores were lower in patients with pinguecula in both groups. The OSDI scores were higher in the CL group. There was no significant difference regarding the OSDI scores between patients with pinguecula and healthy participants in the CL group; however, OSDI scores were significantly higher in patients with pinguecula in control group. There were no significant differences in the ST scores between the groups, and between patients with pinguecula and healthy participants.

CONCLUSION

This is the second study that evaluates the effects of soft CL wearing on pinguecula prevalence. We found that CL wearing does not affect the prevalence of pinguecula. Considering the OSDI scores in patients with pinguecula in the CL group, CL may suppress the irritant symptoms of pinguecula.

Prevalence and Associated Factors of Pterygium Among Adults Living in Kolla Diba Town, Northwest Ethiopia

Background

Pterygium is a disfiguring disease that can potentially lead to blindness. It is more common in warm, windy and dry climates of tropical and sub-tropical regions of Africa. Globally, the prevalence ranging from 0.07% to 53%. Studies conducted on the prevalence of pterygium in developing countries were limited with a wider discrepancy between them. In this study, we aimed to assess the prevalence of pterygium and its associated factors among adults in Kolla Diba town.

Methods

A community-based cross-sectional study was done in Kolla Diba town from May 30-June 16, 2019. A systematic random sampling technique was used to select 627 study participants. The basic ophthalmic examination was performed using portable slit lamp, 3x magnifying loop with torch light and a pretested structured questionnaire was completed. The data entered into EPI INFO version 7 and analyzed using SPSS version 20. Descriptive statistics and binary logistic regression analysis were employed. P-values of <0.05 were considered statistically significant.

Results

A total of 605 study participants were involved with a response rate of 96.5%. Among them, 317 (52.4%) participants were males. The mean age of the respondents was 38.18 ± 15.56 with a range of (18–95) in years. The overall prevalence of pterygium was 112 (18.5% (95% CI (15.6–21.7)). Being widowed (AOR = 7.32 (95% CI: 2.88, 18.57)), outdoor occupation (AOR = 2.50 (95% CI: 1.46, 4.29)), sun exposure (AOR = 2.38 (95% CI: 1.28, 4.43)), wind exposure (AOR = 1.97 (95% CI: 1.04, 3.72)), alcohol drinking (AOR = 2.26 (95% CI: 1.48, 4.63)), and severe blepharitis (AOR = 2.45 (95% CI: 1.48, 4.05)) had statistically significant positive association with pterygium.

Conclusion

The prevalence of pterygium was relatively higher. Being widowed, outdoor occupation, sun exposure, wind exposure, alcohol drinking, and severe blepharitis were significantly associated with the development of pterygium.

Pterygium: new insights

Pterygia are common conjunctival degenerations with well-documented risk factors but an unclear pathogenesis. Better understanding of the pathogenesis of pterygium could lead to improved surgical outcomes and decreased postoperative recurrence. Currently, pterygium excision with conjunctival autograft remains the preferred surgical technique to decrease pterygium recurrence. Many adjuvant therapies have been used in pterygium surgery to varying degrees of success. Topical cyclosporine, an immunosuppressive medication, in conjunction with conjunctival autograft was found to be most successful in decreasing pterygium recurrence according to a recent meta-analysis. Other adjuvant therapies such as mitomycin-C (MMC), 5-fluorouracil (5-FU), and beta-irradiation have also been used, though usage of these may cause multiple adverse effects. Recent research indicates that interactions between mouse double minute 2 (MDM2) and p53 could play a role in the occurrence of pterygium. Nutlin, an MDM2 antagonist, was found to have significantly less toxicity in conjunctival cells when compared with MMC on laboratory analysis of pterygium samples.

Prevalence and associated factors for pterygium in Han and Mongolian adults: a cross-sectional study in inner Mongolian, China

Background

To investigate the prevalence of pterygium and associated factors in Han and Mongolian adults at four survey sites in Inner Mongolia, China.

Methods

We conducted a population-based, cross-sectional study as part of the China National Health Survey (CNHS). By means of a stratified sampling method, we finally included 2651 participants of 30 years of age or older from a total of 3468 eligible residents. Factors associated with pterygium were analysed by a univariate analysis and logistic regression models.

Results

The study population included 1910 Han and 741 Mongolian adults. The mean age ± standard deviation of the study cohort was 48.93 ± 11.06 years. The overall prevalence of pterygium was 6.4% (n = 169); 1.4% (n = 38) of the cases were bilateral and 4.8% (n = 128) were unilateral. The most common grade of pterygium was Grade 2. Based on the results of the univariate analysis, eleven factors were included in a multivariate analysis. The results indicated that age (P < 0.001), outdoor occupation (P = 0.026), and time spent in rural areas (P < 0.001) were significantly associated with pterygium. Sex and ethnicity were not identified as risk factors.

Conclusions

Our results indicated that outdoor occupation, old age and more time spent in rural areas were risk factors for pterygium in Inner Mongolia. At the same time, town as a survey site (Hohhot and Tsining District) was a protective factor for pterygium. Ethnicity, gender, smoking, diabetes and high blood pressure are not associated with pterygium.

Pterygium Prevalence and Its Associations in a Russian Population: The Ural Eye and Medical Study

PURPOSE

To assess the prevalence of pterygia and its associations in a population in Russia.

DESIGN

Population-based cross-sectional study.

METHODS

The Ural Eye and Medical Study was performed in a rural and urban area in Ufa/Bashkortostan 1300 km east of Moscow. Out of 7328 eligible individuals aged 40+ years, 5899 (80.5%) individuals participated and underwent an ocular and systemic examination. Pterygia, defined as conjunctival extensions onto the clear cornea, were diagnosed upon slit-lamp examination and on corneal photographs.

RESULTS

Mean pterygium prevalence (per individual) was 138/5888 (2.3%; 95% confidence intervals [CI]:2.0, 2.7), with bilateral occurrence in 45 individuals (32.6% of patients with pterygium; 0.8% of study population). Pterygium prevalence increased from 0.8% (95% CI: 0.02, 1.6) in the age group from 40 to <45 years to 3.6% (95% CI: 2.1, 5.1) in the age group of 75+ years. In multivariable analysis, higher pterygium prevalence was associated with older age (P = .006; odds ratio [OR]: 1.03; 95% CI: 1.01, 1.04), rural vs urban region of habitation (P < .001; OR: 2.33; 95% CI: 1.57, 3.46), and lower level of education (P = .03; OR: 0.89; 95% CI: 0.81, 0.99), while the pterygium prevalence was statistically independent of sex (P = .34), Russian vs non-Russian ethnicity (P = .59), presence of diabetes mellitus (P = 1.00), arterial hypertension (P = .86), vegetarian vs mixed diet (P = 1.00), blood lipid concentration (P > .30), history of cardiovascular disease (P = .49), or axial length (P = .52).

CONCLUSIONS

In this rural and urban, typically multiethnic Russian study population aged 40+ years, a higher pterygium prevalence (mean: 2.3%) was correlated with older age, rural region of habitation, and lower educational level, while it was statistically independent of most other systemic or ocular parameters. A pterygium was not a biomarker for an internal medical disease.

The Improvement of Dry Eye Symptoms after Pinguecula Excision and Conjunctival Autograft with Fibrin Glue

Purpose

To evaluate the association between pinguecula excision and subsequent improvement in dry eye syndrome.

Methods

We included 30 consecutive patients with primary nasal pinguecula and dry eye symptoms undergoing ocular surgery for the first time. Criteria for pinguecula excision surgery were nasal location, yellowish color, and protrusion of conjunctiva at least 2 times thicker than adjacent normal conjunctiva as measured by anterior segment optical coherence tomography. Our primary outcomes were 3-month postoperative changes in tear film breakup time (TBUT), Schirmer test, and a dry eye symptom score.

Results

30 eyes from 30 different patients (12 men and 18 women) underwent pinguecula excision and conjunctival autografting using fibrin glue. The mean age was 42.5 ± 8.35 (range 28-63) years. The preoperative protrusion ratio of pinguecula was 2.33 ± 0.28 (range 2.00-2.90). Mean preoperative TBUT, Schirmer test, and dry eye symptom scores were 5.10 ± 1.27 seconds, 6.07 ± 2.27 mm, and 2.80 ± 0.76 points. Mean postoperative 3-month TBUT, Schirmer test, and dry eye symptom scores were 7.80 ± 1.13 seconds, 7.27 ± 2.02 mm, and 0.30 ± 0.47 points, respectively. The median pre- and postoperative changes were found to be statistically significant by Wilcoxon signed-rank tests for TBUT, Schirmer test score, and dry eye symptom score.

Conclusion

Surgical excision of pinguecula and conjunctival autograft using fibrin glue is an effective and safe method to improve symptoms of dry eye syndrome.

Comparative Assessment of Tear Function Tests, Tear Osmolarity, and Conjunctival Impression Cytology between Patients with Pterygium and Healthy Eyes

Purpose:

To compare histologic abnormalities of tear film and tear osmolarity between normal eyes and eyes with pterygium.

Methods:

This was a prospective, hospital-based, case–control study involving 95 patients (65 men, 30 women) with unilateral pterygium. The tear meniscus height (TMH), Schirmer's test-1 (SCH-1) score, Rose Bengal staining (RBS) score, tear film breakup time (TBUT), tear osmolarity (TO), and conjunctival impression cytology (CIC) were assessed in both eyes. The Chi-square and Student's t-tests were used to compare the results between the two groups. P values <0.05 were considered statistically significant.

Results:

The mean patient age was 50.9 years, with the largest age group being the 45–55 year-old bracket across both genders. Most patients (82.1%) had nasal pterygium, and 80% were involved in outside activities. The mean assessment values in the case and control groups were as follows: TMH, 0.21 vs. 0.24 mm; SCH-1, 13.2 vs. 17.8 mm; RBS, 4.38 vs. 2.51 points; TBUT, 8.7 vs. 13.2 seconds; TO, 306 vs. 299 mOsm/L (P < 0.001 in all cases). The proportions of abnormal assessment values in the case and control groups were as follows: TMH, 82.1% vs. 3.16%; SCH-1, 20% vs. 2.1%; RBS, 30.53% vs. 4.22%; TBUT, 61.05% vs. 6.3%; TO, 10.52% vs. 1.05%; CIC, 33.7% vs. 7.37% (P < 0.05 for all comparisons).

Conclusion:

This study showed that the quantity and quality of tear film, as well as the number of goblet cells, decreased, but the tear osmolarity increased in eyes with pterygium. Furthermore, the TMH, RBS results, TBUT, and CIC have more precise state of the patient's tear condition with the disease of the pterygium.

Solar Radiation Exposure and Outdoor Work: An Underestimated Occupational Risk

A considerably high number of outdoor workers worldwide are constantly exposed for the majority of their working life to solar radiation (SR); this exposure is known to induce various adverse health effects, mainly related to its ultraviolet (UV) component. The skin and the eye are the principal target organs for both acute and long-term exposure. Actinic keratosis, non-melanoma skin cancers, and malignant melanoma are the main long-term adverse skin effects, whereas in the eye pterygium, cataracts, and according to an increasing body of evidence, macular degeneration may be induced. Despite this, SR exposure risk is currently undervalued, if not neglected, as an occupational risk factor for outdoor workers. SR exposure is influenced by various environmental and individual factors, and occupation is one of the most relevant. For a better understanding of this risk and for the development of more effective prevention strategies, one of the main problems is the lack of available and adequate methods to estimate SR worker exposure, especially long-term exposure. The main aims of this review were to provide a comprehensive overview of SR exposure risk of outdoor workers, including the UV exposure levels and the main methods recently proposed for short-term and cumulative exposure, and to provide an update of knowledge on the main adverse eye and skin effects. Finally, we also outline here preventive interventions to reduce occupational risk.

Occupational Exposure to Solar Radiation at Different Latitudes and Pterygium: A Systematic Review of the Last 10 Years of Scientific Literature

Pterygium is a chronic eye disease: among its recognized risk factors there is long-term exposure to ultraviolet (UV) radiation. The Sun is the main source of UV exposure: according to the World Health Organization, the Population Attributable Fraction of pterygium due to solar radiation (SR) is 42–74%. Outdoor work can deeply influence the eye exposure to solar UV rays, but, despite this, pterygium is currently not adequately considered as a possible occupational disease in this working category, at least in Europe. For this reason, we performed a systematic review of the scientific literature published in the last ten years (2008–2017) considering the role of outdoor work as a risk factor for pterygium, in order to give new support for the prevention of this UV related disease in workers. We identified 29 relevant papers. Our results show that pterygium prevalence highly increased with latitude and mean annual UV index, and outdoor work is one of the most relevant risk factors, as well as age and male sex, both in high risk and in moderate risk World areas considering the environmental UV levels. Accordingly, pterygium occurring in outdoor workers should be considered an occupational disease. Moreover, our findings clearly support the need of further research on more effective prevention of the occupational risk related to long-term solar radiation exposure of the eye.

Efficacy of curcumin in inducing apoptosis and inhibiting the expression of VEGF in human pterygium fibroblasts

Pterygium is an inflammatory and degenerative ocular surface disease, in which the conjunctiva on the cornea grows to form a fibrous tissue in the shape of a triangle. Although pterygium surgery is used broadly in clinical practice, its high recurrence rate poses a great concern for patients and doctors. In the present study, we examined the effects of curcumin on the apoptosis and proliferation of human pterygium fibroblasts (HPFs) in an in vitro culture system. HPFs were incubated with curcumin for 24 to 72 h (5, 20, 80 or 200 µmol/l). The proliferation-inhibiting effects of curcumin were assayed by MTT assay at different time points and at various concentrations. The expression of vascular endothelial growth factor (VEGF) in each group was detected by RT-qPCR and ELISA. The apoptotic effects of curcumin were detected by flow cytometry (FCM). Treatment with curcumin at 80 µmol/l for 48 h significantly inhibited HPF proliferation. Curcumin significant induced the apoptosis of HPFs. Our findings thus suggest that curcumin suppress cell proliferation in the pterygium by inducing HPF apoptosis and inhibiting VEGF expression. Thus, curcumin has potential for use as a novel agent for the treatment of pterygium in the near future.

Risk Factors for Pterygium in Ilam Province, Iran

Purpose:

To evaluate the risk factors for pterygium in the dry, high altitude province of Ilam, Iran.

Methods:

The study included patients who presented to ophthalmology clinic. The patients were divided into two groups: 210 diagnosed with pterygium or pinguecula (unilateral or bilateral), and 210 healthy controls. Demographic variables, living environment, disease type, disease laterality, family history of pterygium as well as history of smoking, working outdoors, baking, welding, ocular conditions (trachoma keratopathy, glaucoma, refractive error, and dry eye), use of glasses, ultraviolet light exposure, and systemic conditions were collected from both groups and compared for risk assessment.

Results:

Univariate analysis revealed that age (P = 0.001), sex (P = 0.001), family history of pterygium (P = 0.001), positive history of smoking (P < 0.001), history of baking (P = 0.045), welding experience (P < 0.001), severe blepharitis (P < 0.001), hyperopia (P < 0.001), dry eye (P < 0.001), hypertension (P < 0.001), ischemic heart disease (P < 0.001), obesity (P = 0.038), and primary residential area (P = 0.025) had significant associations with increased incidence of pterygium. However, in multivariate analysis, only family history of pterygium, cigarette smoking, history of baking, age, and severe blepharitis were significantly associated with the incidence of pterygium (P<0.001, P<0.001, P = 0.002, P = 0.023 and P = 0.002, respectively).

Conclusion:

This study tested more risk factors related to the prevalence of pterygium compared to previous studies. It also confirmed previously established risk factors. Family history of pterygium and blepharitis were risk factors that have not been reported in previous studies and were found to be significantly associated with the development of pterygium in this study.

The prevalence and determinants of pterygium in rural areas

Purpose

To evaluate the prevalence of pterygium and its determinants in the underserved, rural population of Iran.

Methods

In this cross-sectional study of 3851 selected individuals, 86.5% participated in the study, and the prevalence of pterygium was evaluated in 3312 participants. A number of villages were selected from the north and south of Iran using multistage cluster sampling. Pterygium was diagnosed by the ophthalmologist using slit-lamp examination.

Results

The mean age of the study participants was 37.3 ± 21.4 years (2–93 years), and 56.3% (n = 1865) of them were women. The prevalence of pterygium was 13.11% [95%confidence interval (CI):11.75–14.47]. The prevalence of pterygium was 14.99 (95%CI:12.79–17.19) in men and 12.07 (95%CI:10.3–13.84) in women. Pterygium was not seen in children below the age of 5 years. The prevalence of pterygium increased linearly with age; the lowest and highest prevalence of pterygium was observed in the age group 5–20 years (0.19%) and 61–70 years (28.57%). Evaluation of the relationship between pterygium with age, sex, educational level, and place of living using a multiple model showed that age, living in the south of Iran, and low educational level were correlated with pterygium.

Conclusion

The prevalence of pterygium was significantly higher in Iranian villages when compared with the results of previous studies. This finding may represent the effect of a rural lifestyle and its risk factors.

Clinical Presentation of Ocular Surface Squamous Neoplasia in Kenya

IMPORTANCE

There is a trend toward treating conjunctival lesions suspected to be ocular surface squamous neoplasia (OSSN) based on the clinical impression.

OBJECTIVE

To describe the presentation of OSSN and identify clinical features that distinguish it from benign lesions and subsequently evaluate their recognizability.

DESIGN, SETTING, AND PARTICIPANTS

Prospective multicenter study in Kenya from July 2012 through July 2014 of 496 adults presenting with conjunctival lesions. One histopathologist examined all specimens. Six additional masked ophthalmologists independently examined photographs from 100 participants and assessed clinical features.

EXPOSURES

Comprehensive history, slitlamp examination, and photography before excision biopsy.

MAIN OUTCOMES AND MEASURES

Frequency of clinical features in OSSN and benign lesions were recorded. Proportions and means were compared using χ2, Fisher exact test, or t test as appropriate. Interobserver agreement was estimated using the κ statistic. Examiners' assessments were compared with a reference.

RESULTS

Among 496 participants, OSSN was the most common (38%) histological diagnosis, followed by pterygium (36%) and actinic keratosis (19%). Patients with OSSN were slightly older (mean [SD] age, 41 [11.6] vs 38 [10.9] years; P = .002) and tended to have lower levels of education than patients with benign lesions (P = .001). Females predominated (67% of OSSN vs 64% of benign lesions; P = .65). Human immunodeficiency virus infection was common among patients with OSSN (74%). The most common location was the nasal limbus (61% OSSN vs 78% benign lesions; P < .001). Signs more frequent in OSSN included feeder vessels (odds ratio [OR], 5.8 [95% CI, 3.2-10.5]), moderate inflammation (OR, 3.5 [95% CI, 1.8-6.8]), corneal involvement (OR, 2.7 [95% CI, 1.8-4.0]), leukoplakia (OR, 2.6 [95% CI, 1.7-3.9]), papilliform surface (OR, 2.1 [95% CI, 1.3-3.5]), pigmentation (OR, 1.5 [95% CI, 1.0-2.2]), temporal location (OR, 2.0 [95% CI, 1.2-3.2]), circumlimbal location (6.7% vs 0.3%; P < .001), severe inflammation (6.7% vs 0.3%; P < .001), and larger mean (SD) diameter (6.8 [3.2] vs 4.8 [2.8] mm; P < .001). All OSSN signs were also observed in benign lesions. There was slight to fair interobserver agreement in assessment of most signs and diagnosis (κ, 0.1-0.4). The positive predictive value of clinical appearance in identifying OSSN was 54% (interquartile range, 51%-56%) from photographs in which prevalence was 32%.

CONCLUSIONS AND RELEVANCE

With overlapping phenotypes and modest interobserver agreement, OSSN and benign conjunctival lesions are not reliably distinguished clinically. Point-of-care diagnostic tools may help.

Prevalence and severity of pterygium among commercial motorcycle riders in south eastern Nigeria

BACKGROUND

Pterygium is common among outdoor workers who are daily exposed to sunlight and dust due to repeated conjunctival /corneal drying and micro-trauma especially in the tropics. Commercial motorcyclists in Nigeria are outdoor workers who spend the greater part of the day outdoors under the intense heat and dust characteristic of this part of the world and would therefore be largely predisposed to developing this conjunctival disorder.

OBJECTIVE

The aim of this study is to determine the prevalence and severity of pterygium among these workers and relate these findings to their duration of work.

METHODS

A cross sectional study with a multi stage random sampling design was used to choose the 615 subjects enrolled in the study.

RESULTS

The prevalence for pterygium was 19.3% (206 eyes) with stage 1 occurring mostly (52%) followed by stage 2(46%). Pterygium was common among riders who had been riding for 5 years or less. The relationship between duration of riding and pterygium severity was significant (p=0.009). This prevalence was unaffected by the use of regular sun glasses (p=0.188).

CONCLUSION

A strong relationship exists between commercial motorcycle riding and development of pterygium not affected by using regular sunglasses. We recommend that helmets with full face shields and/or proper UV protected riding goggles where the helmets have no face shield be enforced by the regulation bodies so as to reduce the prevalence of these disorders.

Relationship between pinguecula formation and exposure to tandoor ovens in a hospital-based study

AIM

To investigate the relationship between pinguecula and the use of tandoor ovens.

METHODS

A total of 539 women, ranging in age from 20 to 86y who attended an outpatient clinic were enrolled. All the patients were asked whether they used tandoor ovens. Women exposed to tandoor ovens (n=286) were accepted as participants in the study group and they were compared with participants in the control group (n=253). The age, presence of pinguecula, duration of exposure to tandoor ovens as years and occupations were recorded for all the subjects.

RESULTS

Mean duration for exposure to tandoor was 20.26y (range 1-62y) in the study group. The rate of pinguecula in the study group was 82.2% (235/286), and the rate in the control group was 37.5% (95/253); this difference was statistically significant (P<0.05). Pinguecula was seen in 61.2% (330/539) of all the participants.

CONCLUSION

Pinguecula is strongly associated with exposure to tandoor ovens.

Prevalence of and risk factors for pterygia in a rural Northern Chinese population

PURPOSE

To determine the prevalence of and associated risk factors for pterygia development in a high-latitude-dwelling Northern Chinese population.

METHODS

A prospective population-based survey was conducted between November 2008 and July 2009. A stratified, clustered, randomized sampling procedure was used to select 8445 subjects, aged ≥18 years, all with diagnosed, graded pterygia. Risk factors associated with the occurrence of pterygia were evaluated according to logistic regression models.

RESULTS

A total of 8445 residents (aged 18-94 years) from the Heilongjiang Province, China, participated in the study. Of these, 208 (2.5%) had at least one diagnosed pterygium. The prevalence of bilateral pterygia was 1.2% (95% confidence interval, CI, 1.0-1.4%). According to multivariable analysis, pterygia were significantly more likely to occur in persons aged 70-94 years than in those aged 18-39 years (odds ratio, OR, 29.0, 95% CI 13.6-61.6, p < 0.01). Pterygia were significantly associated with male sex (OR 1.9, 95% CI 1.4-2.6, p < 0.01) and outdoor work (OR 1.8, 95% CI 1.2-2.6, p < 0.01). Multivariable analysis indicated that pterygia were not associated with smoking status (OR 1.0, 95% CI 0.8-1.4) or alcohol intake (OR 1.0, 95% CI 0.7-1.4, p > 0.05).

CONCLUSIONS

This study details the occurrence of and risk factors for pterygia in a Chinese population residing in a rural, high-latitude, cold-climate area of Northern China. The primary risk factors for pterygia were age, male sex, and outdoor work.

Prevalence and risk factors for pterygium in rural older adults in Shandong Province of China: a cross-sectional study

To investigate the prevalence and risk factors for pterygium in rural older adults in Shandong Province, eastern China, a population-based, cross-sectional study was performed from April to July 2008. By means of cluster random sampling methods, a total of 19,583 people aged 50 years or above were randomly selected from four rural counties. Out of 19,583 people, 1,767 residents were excluded mainly because they were migrant workers when this study was performed. Finally, 17,816 (90.98%) people were included as eligible subjects. They received a comprehensive eye examination and a structured questionnaire voluntarily. Patients with pterygium were defined as having pterygium at the time of survey or pterygium surgery had been performed. 1,876 people were diagnosed as pterygium, either unilateral (1,083) or bilateral (793), which is equivalent to a prevalence of 10.53% (95% CI, 10.08–10.98). The multivariate logistic regression analysis showed that pterygium was independently associated with older age, areas, outdoor time, educational level, and use of hat and/or sunglasses. The prevalence of pterygium increased with age and hours spent under sunshine per day. Meanwhile, the higher the educational level and the more use of hat and/or sunglasses, the lower the pterygium prevalence.

The prevalence of pterygium in Alkhobar: A hospital-based study

Objective:

To analyze the epidemiology of pterygium in a hospital-based population in Alkhobar, which is located in the eastern province of Saudi Arabia.

Materials and Methods:

This was a retrospective, non-randomized, and consecutive case study. Out of 88,666 patients who were seen in the ophthalmology clinic between January 1995 through the end of December 2010, 116 patients were diagnosed with advanced pterygium. The medical records of these patients were evaluated.

Results:

The overall prevalence of pterygium was found to be 0.074%. There was no significant difference by either gender, side, or by laterality (P > 0.05). A significant increase was noticed in the prevalence of pterygium with increasing age and nasal location (P < 0.05).

Conclusion:

The overall prevalence rate of pterygium in Alkhobar is low when compared with results reported from other areas of the world.

Prevalence and associated factors for pterygium in rural agrarian central India. The central India eye and medical study

Purpose

To evaluate the prevalence of pterygia and associated factors in a rural population in a mostly undeveloped agrarian region.

Methods

The Central India Eye and Medical Study is a population-based study performed in a rural region of Central India. The study comprised 4711 subjects (aged 30+ years). A detailed ophthalmic and medical examination was performed. A pterygium was diagnosed during the slit lamp examination and confirmed on corneal photographs. It was defined as a fleshy fibrovascular growth, crossing the limbus and typically seen on the nasal, and sometimes temporal, conjunctiva.

Results

A pterygium was detected in 798 eyes (prevalence rate: 8.47±0.29%) of 608 (12.91±0.49%) subjects. Bilateral pterygia were present in 190 subjects (4.0% of study population). Pterygia prevalence increased from 6.7±0.8% in the age group 30-39 years, to 13.5±1.2% in the age group 50-59 years, to 25.3±2.1% in the age group 70-79 years. Prevalence of pterygia was associated with older age (P<0.001; regression coefficient B: 0.02; odds ratio (OR): 1.02; 95%CI: 1.01, 1.03), male gender (P<0.001;B:-0.73;OR: .48;95%CI:0.39,0.61), lower level of education (P<0.001;B:-0.30;OR:0.74;95%CI:0.69,0.80), lower body height (P=0.001;B:-0.02;OR:0.98;95%CI:0.97,0.99), and higher cylindrical refractive error (P<0.001;B:0.23;OR:1.26;95%CI:1.18,1.34). If the education level was dropped, the number of hours spent with vigorous activity outdoors (P=0.001;B:0.001;OR:1.001;95%CI:1.000,1.0001) was significantly associated with the prevalence of pterygia, in addition to older age (P<0.001;B:0.03;OR:1.03;95%CI:1.03,1.04), male gender (P<0.001;B:-0.49;OR:0.62;95%CI:0.49,0.77), lower body height (P=0.005;B:-0.02;OR:0.98;95%CI:0.97,0.99), and higher cylindrical refractive error (P<0.001;B:0.23;OR:1.25;95%CI:1.18,1.34).

Conclusions

Pterygium prevalence in rural Central India is about 13% among adult Indians aged 30+ years. Older age, male gender, lower educational level, lower body height and more time spent outdoors with vigorous work were associated factors. Since the living conditions in the study location were mostly untouched by modern developments, the results may show the prevalence and associations of pterygia without major medical or technologic influences.

Geographical prevalence and risk factors for pterygium: a systematic review and meta-analysis

OBJECTIVE

Pterygium is considered to be a proliferative overgrowth of bulbar conjunctiva that can induce significant astigmatism and cause visual impairment; this is the first meta-analysis to investigate the pooled prevalence and risk factors for pterygium in the global world.

DESIGN

A systematic review and meta-analysis of population-based studies.

SETTING

International.

PARTICIPANTS

A total of 20 studies with 900 545 samples were included.

PRIMARY OUTCOME MEASURE

The pooled prevalence and risk factors for pterygium.

RESULTS

20 studies were included. The pooled prevalence of pterygium was 10.2% (95% CI 6.3% to 16.1%). The pooled prevalence among men was higher than that among women (14.5% vs 13.6%). The proportion of participants with unilateral cases of pterygium was higher than that of participants with bilateral cases of pterygium. We found a trend that the higher pooled prevalence of pterygium was associated with decreasing geographical latitude and age in the world. The pooled OR was 2.32 (95% CI 1.66 to 3.23) for the male gender and 1.76 (95% CI 1.55 to 2.00) for outdoor activity, respectively.

CONCLUSIONS

The pooled prevalence of pterygium was relatively high, especially for low latitude regions and the elderly. There were many modifiable risk factors associated with pterygium to which healthcare providers should pay more attention.

Oral doxycycline reduces pterygium lesions; results from a double blind, randomized, placebo controlled clinical trial

PURPOSE

To determine whether oral doxycycline treatment reduces pterygium lesions.

DESIGN

Double blind, randomized, placebo controlled clinical trial.

PARTICIPANTS

98 adult patients with primary pterygium.

METHODS

Patients were randomly assigned to receive 100 mg oral doxycycline twice a day (49 subjects), or placebo (49 subjects), for 30 days. Photographs of the lesion were taken at the time of recruitment and at the end of the treatment. Follow-up sessions were performed 6 and 12 months post-treatment. Statistical analyses for both continuous and categorical variables were applied. p values of less than 0.05 were considered to indicate statistical significance.

MAIN OUTCOME MEASURES

The primary endpoint was the change in lesion size after 30 days of treatment.

RESULTS

The primary endpoint was not met for the whole population but subgroup analysis showed that doxycycline was effective in patients of Caucasian origin while other ethnicities, mostly Hispanic, did not respond to the treatment. Moreover, there was a correlation between age and better response (p = 0.003). Adverse events were uncommon, mild, and in agreement with previous reports on short doxycycline treatments.

CONCLUSIONS

Oral doxycycline was superior to placebo for the treatment of primary pterygia in older Caucasian patients. These findings support the use of doxycycline for pterygium treatment in particular populations.

TRIAL REGISTRATION

European Union Clinical Trials Register EudraCT 2008-007178-39.