1
|
Kanclerz P, Bazylczyk N, Przewłócka K, Khoramnia R, Atchison DA, Tuuminen R. Risk Factors for Corneal Monochromatic Aberrations and Implications for Multifocal and Extended Depth-of-Focus Intraocular Lens Implantation. J Refract Surg 2024; 40:e420-e434. [PMID: 38848055 DOI: 10.3928/1081597x-20240416-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
PURPOSE To discuss factors influencing corneal aberrations that might influence the optical quality after intraocular lens (IOL) implantation. METHODS PubMed and Scopus were the main resources used to search the medical literature. An extensive search was performed to identify relevant articles concerning factors influencing the level of corneal aberrations as of August 27, 2023. The following keywords were used in various combinations: corneal, aberrations, defocus, astigmatism, spherical aberration, coma, trefoil, quadrafoil, intraocular lens, and IOL. RESULTS Conclusive evidence is lacking regarding the correlation between age and changes in corneal aberrations. Patients with astigmatism have greater corneal higher-order aberrations than those with minimal astigmatism, particularly concerning trefoil and coma. Increased levels of corneal higher-order aberrations are noted following contact lens wear, in patients with dry eye disease, and with pterygium. Increased higher-order aberrations have been reported following corneal refractive surgery and for 3 months following trabeculectomy; regarding intraocular lens surgery, the results remain controversial. CONCLUSIONS Several factors influence the level of corneal higher-order aberrations. Multifocal and extended depth-of-focus IOLs can share similarities in their optical properties, and the main difference arises in their design and performance with respect to spherical aberration. Preoperative evaluation is critical for proper IOL choice, particularly in corneas with risk of high levels of aberrations. [J Refract Surg. 2024;40(6):e420-e434.].
Collapse
|
2
|
Ha DH, Kim KW. Timing optimization for primary pterygium excision with conjunctival-limbal autograft to restore the corneal optical properties. Acta Ophthalmol 2024. [PMID: 38647407 DOI: 10.1111/aos.16694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To propose the optimal value of baseline corneal astigmatism and pterygial morphological profiles for primary pterygium surgery to restore the corneal optical properties. METHODS We analysed 93 eyes from 84 subjects with nasal-only primary pterygium who underwent pterygium excision with conjunctival-limbal autograft and were assessed perioperatively using anterior segment swept-source optical coherence tomography (AS SS-OCT). We collected data on anterior corneal astigmatism (ACA) and root mean square (RMS) values for anterior corneal lower- (LoA) and higher-order aberrations (HoA) as corneal optical properties using AS SS-OCT. Using preoperative ACA and four pterygial morphological profiles (horizontal invasion length [HIL], height, thickness and the ratio of residual corneal thickness [RCT] to central corneal thickness [CCT]) measured in AS SS-OCT, we plotted receiver operating characteristic (ROC) curves. These curves aimed to determine cut-off values predicting a perioperative decrease exceeding 50% in ACA, RMS LoA and RMS HoA, as well as postoperative residual ACA higher than 1.25D. RESULTS Preoperative ACA > 1.42D (AUC = 0.934) and >3.60D (AUC = 0.946) proved most effective in identifying subjects with perioperative decrease exceeding in ACA and RMS LoA, respectively. HIL > 3.34 mm (AUC = 0.941) was most effective in distinguishing subjects with perioperative reduction exceeding 50% in RMS HoA. Preoperative ACA > 5.78D (AUC = 0.776) and HIL > 5.03 mm (AUC = 0.700) significantly distinguished subjects with postoperative residual ACA higher than 1.25D. CONCLUSION Optimizing the restoration of corneal astigmatism and aberrations after pterygium surgery may be facilitated by determining the optimal surgical timing based on preoperative ACA and HIL values.
Collapse
Affiliation(s)
- Dong Hee Ha
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Kyoung Woo Kim
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| |
Collapse
|
3
|
Xu W, Li X. The effect of pterygium on front and back corneal astigmatism and aberrations in natural-light and low-light conditions. BMC Ophthalmol 2024; 24:7. [PMID: 38178053 PMCID: PMC10768295 DOI: 10.1186/s12886-023-03270-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND To investigate the effect of different sizes of pterygium on the front and back corneal topography, refractive changes and aberrations in natural-light and low-light conditions. METHODS Sixty subjects with unilateral primary nasal pterygium were enrolled in this study. All the patients' uncorrected, best spectacle-corrected visual acuity, corneal topographic aberration data in 3 mm and 7 mm areas were collected. The pterygium size was evaluated by the slit-lamp photography and Sirius Scheimpflug Analyzer. RESULTS The front topographic astigmatism values, corneal total aberrations, and higher-order aberrations in 3 mm and 7 mm areas were higher in the pterygium group than those in the control group. The pterygium horizontal length and thickness were moderately to strongly correlated with astigmatism and RMS of aberrations, while pterygium vertical length showed no or just mild correlation with the corneal astigmatism and aberrations. Compared to the readings in 3 mm area, the front and back corneal astigmatism and aberrations were larger in 7 mm area. CONCLUSIONS Pterygium led to visual impairment by inducing astigmatism and aberrations. In low-light condition, the visual function worsened due to increased corneal astigmatism values and aberrations.
Collapse
Affiliation(s)
- Weiwei Xu
- Shanghai Aier Eye Hospital, NO. 83 Wuzhong Road, Xuhui District, Shanghai, 200031, China
- Shanghai Aier Eye Institute, PR, NO. 83 Wuzhong Road, Xuhui District, Shanghai, 200031, China
| | - Xia Li
- Shanghai Aier Eye Hospital, NO. 83 Wuzhong Road, Xuhui District, Shanghai, 200031, China.
- Shanghai Aier Eye Institute, PR, NO. 83 Wuzhong Road, Xuhui District, Shanghai, 200031, China.
| |
Collapse
|
4
|
Yoon S, Na M, Eom Y, Kim HM, Song JS. Morphometric Measurement of Pterygium with Anterior Segment Optical Coherence Tomography and Relationship with Astigmatism. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.8.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We used anterior segment optical coherence tomography (AS-OCT) to measure the pterygial subepithelial invasion length and thickness before and after surgery, and to evaluate the corneal epithelium and the extent of astigmatism.Methods: This was a retrospective study. Ten eyes that underwent pterygial excision surgery were analyzed. We used corneal topographic data to assess astigmatism before surgery and employed AS-OCT to measure corneal epithelial thickness and the length of subepithelial invasion. We measured the relative pterygial length, width, and area on anterior segment photographs. Corneal topographic assessment and AS-OCT were repeated 1 month after surgery. Multiple regression and Pearson correlation analyses were used to analyze the relationships between normalization of astigmatism and the size and thickness of the excised pterygium.Results: The mean With-the-Rule proportion of preoperative astigmatism was 2.9 ± 2.3 D and the mean corneal epithelial thickness 269.60 ± 84.17 µm. The mean thickness of the excised pterygia was 210.73 ± 80.36 µm. Pterygial thickness was significantly associated with the extent of preoperative With-the-Rule astigmatism and the normalized With-the-Rule astigmatism after pterygial excision. These correlations were stronger than those of the relative pterygial length, width, and area. The mean subepithelial invasion length was 595.00 ± 310.32 µm.Conclusions: An increase in pterygial epithelial thickness influenced the extent of With-the-Rule astigmatism to a much greater extent than did the relative pterygial length, width, and area. AS-OCT measurement of the subepithelial invasion length identifies the required excisional area prior to surgery.
Collapse
|
5
|
Application of a Deep Learning System in Pterygium Grading and Further Prediction of Recurrence with Slit Lamp Photographs. Diagnostics (Basel) 2022; 12:diagnostics12040888. [PMID: 35453936 PMCID: PMC9029774 DOI: 10.3390/diagnostics12040888] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The aim of this study was to evaluate the efficacy of a deep learning system in pterygium grading and recurrence prediction. Methods: This was a single center, retrospective study. Slit-lamp photographs, from patients with or without pterygium, were collected to develop an algorithm. Demographic data, including age, gender, laterality, grading, and pterygium area, recurrence, and surgical methods were recorded. Complex ocular surface diseases and pseudopterygium were excluded. Performance of the algorithm was evaluated by sensitivity, specificity, F1 score, accuracy, and area under the receiver operating characteristic curve. Confusion matrices and heatmaps were created to help explain the results. Results: A total of 237 eyes were enrolled, of which 176 eyes had pterygium and 61 were non-pterygium eyes. The training set and testing set were comprised of 189 and 48 photographs, respectively. In pterygium grading, sensitivity, specificity, F1 score, and accuracy were 80% to 91.67%, 91.67% to 100%, 81.82% to 94.34%, and 86.67% to 91.67%, respectively. In the prediction model, our results showed sensitivity, specificity, positive predictive value, and negative predictive values were 66.67%, 81.82%, 33.33%, and 94.74%, respectively. Conclusions: Deep learning systems can be useful in pterygium grading based on slit lamp photographs. When clinical parameters involved in the prediction of pterygium recurrence were included, the algorithm showed higher specificity and negative predictive value in prediction.
Collapse
|
6
|
Influence of Overhanging Bleb on Corneal Higher-Order Aberrations after Trabeculectomy. J Clin Med 2021; 11:jcm11010177. [PMID: 35011917 PMCID: PMC8745328 DOI: 10.3390/jcm11010177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022] Open
Abstract
Recent advances in ocular aberrometry have revealed that ocular surgery increases ocular and corneal higher-order aberrations. This retrospective single-center study aimed to examine the effects of the overhanging bleb on corneal higher-order aberrations using a wavefront analyzer. We included 61 eyes from 50 patients with overhanging bleb after trabeculectomy with a fornix-based conjunctival flap using mitomycin C (overhanging bleb group) and 65 eyes from 54 glaucoma patients with no history of glaucoma surgery (control group). Corneal higher-order aberrations (total higher-order aberrations, coma aberrations, coma-like aberrations, spherical aberrations, and spherical-like aberrations) on a 4 mm pupil diameter were measured using the TOPCON KR-1W wavefront analyzer. Corneal coma aberrations were higher in the overhanging bleb group than in the control group (0.16 ± 0.13 μm and 0.10 ± 0.05 μm, respectively; p = 0.042). Corneal coma-like aberrations were also higher in the overhanging bleb group than in the control group (0.31 ± 0.32 μm and 0.16 ± 0.09 μm, respectively; p = 0.022). With an increasing ratio of cornea covered by the bleb to the entire cornea, all corneal higher-order aberrations increased except for corneal coma-like aberrations. Overhanging bleb after trabeculectomy with a fornix-based conjunctival flap using mitomycin C and its size influenced corneal higher-order aberrations.
Collapse
|
7
|
Shahraki T, Arabi A, Feizi S. Pterygium: an update on pathophysiology, clinical features, and management. Ther Adv Ophthalmol 2021; 13:25158414211020152. [PMID: 34104871 PMCID: PMC8170279 DOI: 10.1177/25158414211020152] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/06/2021] [Indexed: 01/16/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Toktam Shahraki
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arabi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, 16666, Iran
| | - Sepehr Feizi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Corneal topography in keratoconus evaluated more than 30 years after penetrating keratoplasty: a Fourier harmonic analysis. Sci Rep 2020; 10:14880. [PMID: 32913233 PMCID: PMC7483710 DOI: 10.1038/s41598-020-71818-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/07/2020] [Indexed: 12/03/2022] Open
Abstract
The aim of this observational study was to examine the characteristics of anterior and posterior corneal topography in keratoconic eyes more than 30 years after penetrating keratoplasty (PK). Patients who maintained clear grafts for more than 30 years after PK were included and divided into the keratoconus (KC) group or other diseases (Others) group, based on the primary indication. Twenty-six eyes of 26 patients were included. The KC group and the Others group included 14 eyes and 12 eyes, respectively. The KC group participants were younger at the time of surgery (P = 0.03). No differences were found in best-spectacle-corrected visual acuity, keratometric power, and central-corneal-thickness. Based on corneal topography using Fourier harmonic analyses, regular astigmatism in the anterior cornea was significantly larger (P = 0.047) and the spherical component in the posterior cornea was significantly lower (P = 0.01) in the KC group. The area under the receiver operating characteristic curve of the spherical component, regular astigmatism, asymmetry component, and higher-order irregularity were 66.07%, 63.10%, 57.14%, and 59.23%, respectively, in the anterior cornea and 80.65%, 52.98%, 63.10%, and 63.99%, respectively, in the posterior cornea. Our results suggested that Fourier harmonic analysis of corneal topography could be useful for patients with KC long after PK.
Collapse
|
9
|
Ting DSJ, Liu YC, Patil M, Ji AJS, Fang XL, Tham YC, Lee YF, Htoon HM, Mehta JS. Proposal and validation of a new grading system for pterygium (SLIT2). Br J Ophthalmol 2020; 105:921-924. [PMID: 32788329 DOI: 10.1136/bjophthalmol-2020-315831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/06/2020] [Accepted: 07/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIMS To propose and validate a new pterygium grading system based on slit-lamp evaluation. METHODS This prospective cross-sectional study included 217 patients with pterygium. All patients underwent slit-lamp examination, and slit-lamp photographs were independently graded by two graders twice. A total of eight parameters were evaluated and all parameters were assigned with a score of 1-4 (normal-severe). Intra-rater and inter-rater reliability as determined by weighted Cohen's kappa analysis. RESULTS A total of 868 independent assessment, based on 217 slit-lamp images, were performed by two graders. For conjunctival assessment, the intra-rater reliability was excellent for body thickness (κ=0.81-0.89) and size at limbus (κ=0.87-0.92), substantial-to-excellent for body vascularity (κ=0.72-0.86), and moderate-to-excellent for body length (κ=0.57-0.81), whereas the inter-rater reliability was excellent for size at limbus (κ=0.86), substantial for body thickness (κ=0.72-0.73) and body vascularity (κ=0.66-0.75), and moderate for body length (κ=0.54-0.57). For corneal assessment, the intra-rater reliability was excellent for all four parameters (κ=0.84-0.90) whereas the inter-rater reliability was excellent for head length (κ=0.86-0.87), substantial-to-excellent for head vascularity (κ=0.78-0.82), substantial for Stocker's line (κ=0.79-0.80) and head thickness (κ=0.67-0.69). The grading system was named SLIT2, which included S tocker's line, S ize at limbus, L ength of head/body, I njection/vascularity of body/head, and T hickness of body/head. CONCLUSION The proposed SLIT2 grading system, consisting of eight components, may serve as a reliable tool to standardise the reporting of pterygium severity and disease recurrence for clinical and research applications.
Collapse
Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, University of Nottingham, Nottingham, UK.,Singapore Eye Research Institute, Singapore, Singapore
| | - Yu-Chi Liu
- Singapore Eye Research Institute, Singapore, Singapore.,Cornea And Ext Disease, Singapore National Eye Centre, Singapore, Singapore
| | - Moushmi Patil
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Xiao Ling Fang
- Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology, Shanghai Eye Diseases Prevention and Treatment Center, Shanghai, China
| | | | - Yi-Fang Lee
- Ophthalmology, Singapore National Eye Centre, Singapore, Singapore
| | - Hla M Htoon
- Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore, Singapore .,Cornea And Ext Disease, Singapore National Eye Centre, Singapore, Singapore
| |
Collapse
|
10
|
Young AL, Cao D, Chu WK, Ng TK, Yip YW, Jhanji V, Pang CP. The Evolving Story of Pterygium. Cornea 2018; 37 Suppl 1:S55-S57. [DOI: 10.1097/ico.0000000000001744] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Minami K, Tokunaga T, Okamoto K, Miyata K, Oshika T. Influence of pterygium size on corneal higher-order aberration evaluated using anterior-segment optical coherence tomography. BMC Ophthalmol 2018; 18:166. [PMID: 29986671 PMCID: PMC6038341 DOI: 10.1186/s12886-018-0837-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 06/28/2018] [Indexed: 11/24/2022] Open
Abstract
Background The prospective observation study aimed to evaluate changes in corneal higher-order aberrations induced by advancement of pterygium using an anterior-segment optical coherence tomography (AS-OCT) and Zernike aberration analysis. Methods The corneal topography of 284 eyes with primary pterygia originating from the nasal region was measured using an AS-OCT (SS-1000, Tomey). With anterior corneal elevation data, Zernike polynomial coefficients were calculated in diameters of 1.0, 3.0, and 5.0 mm, and the coma, spherical, coma-like, spherical-like, and total higher-order aberrations were obtained. Pterygium size was also measured as a ratio of positions of the pterygium end with respect to the corneal diameter and categorized in eight classes: less than 15%, 15–20%, 20–25%, 25–30%, 30–35%, 35–40%, 40–45, and 45% or larger. Increases in the aberrations were analyzed with reference to those in eyes with pterygium size < 15%. Results The mean age of the participants was 69.3 years, and the pterygium size ranged from 2 to 57% (mean: 28.8%). The coma aberration significantly increased when the pterygium size was 45% or larger in 1.0 and 3.0 mm diameters and over 25–30% in 5.0 mm diameter. Similar increases were found in the pterygium sizes exceeding 45, 40, and 25%, respectively, in the coma-like, spherical-like, and total higher-order aberrations. On contrast, there was no increase in the spherical aberration. Conclusion Increases in higher-order aberrations reflected the pterygium size, and significant aberrations were induced in 5.0 mm diameter when the end exceeded 25% of corneal diameter. The use of AS-OCT and Zernike analysis could enable objective grading of pterygium advancement based on changes in corneal optics. Electronic supplementary material The online version of this article (10.1186/s12886-018-0837-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Keiichiro Minami
- Miyata Eye Hospital, 6-3 Kurahara-cho, Miyakonojo, Miyazaki, 885-0051, Japan.
| | - Tadatoshi Tokunaga
- Miyata Eye Hospital, 6-3 Kurahara-cho, Miyakonojo, Miyazaki, 885-0051, Japan
| | | | - Kazunori Miyata
- Miyata Eye Hospital, 6-3 Kurahara-cho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| |
Collapse
|
12
|
Lešin M, Paradžik M, Marin Lovrić J, Olujić I, Ljubić Ž, Vučinović A, Bućan K, Puljak L. Cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery (CAGE CUP): study protocol of a randomised controlled trial. BMJ Open 2018; 8:e020714. [PMID: 29950464 PMCID: PMC6020953 DOI: 10.1136/bmjopen-2017-020714] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pterygium is a non-cancerous growth of the conjunctival tissue over the cornea that may lead to visual impairment in advanced stages, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence of pterygium is a frequent problem. It has been previously shown that fibrin glue may result in less recurrence and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery. However, fibrin glue is a biological material and it carries the risk of transmitting infectious agents from pooled and single-donor blood donors and anaphylaxis in susceptible individuals. Cauterisation is another surgical option, and it would be advantageous to know whether cauterisation may be superior surgical option compared with fibrin glue. This protocol describes the rationale and design of the randomised controlled trial (RCT) in which we will compare cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery. METHODS AND ANALYSES This will be a parallel group RCT comparing cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery. Computer-generated randomisation will be used, and allocation concealment will be conducted using sequentially numbered opaque sealed envelopes. Surgeons will not be blinded to the procedures, but participants, other investigators and outcome assessors will be blinded. Adult participants with primary pterygium operated in a tertiary hospital in Split, Croatia, will be included. Primary outcome will be recurrence of pterygium, defined as any regrowth of tissue from the area of excision across the limbus onto the cornea after 180 days. ETHICS AND DISSEMINATION The trial was approved by the ethics review board of the University Hospital Split (500-03/17-01/68). Results will be disseminated at conferences and through peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03321201; Pre-results.
Collapse
Affiliation(s)
- Mladen Lešin
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Martina Paradžik
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | | | - Ivana Olujić
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Žana Ljubić
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Ana Vučinović
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Kajo Bućan
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Livia Puljak
- Laboratory for Pain Research Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Split, Croatia
- Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia
| |
Collapse
|
13
|
Detection of increase in corneal irregularity due to pterygium using Fourier series harmonic analyses with multiple diameters. Jpn J Ophthalmol 2018. [PMID: 29532273 DOI: 10.1007/s10384-018-0583-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine steep increase of corneal irregularity induced by advancement of pterygium. METHODS A total of 456 eyes from 456 consecutive patients with primary pterygia were examined for corneal topography and advancement of pterygium with respect to the corneal diameter. Corneal irregularity induced by the pterygium advancement was evaluated by Fourier harmonic analyses of the topographic data that were modified for a series of analysis diameters from 1 mm to 6 mm. Incidences of steep increases in the asymmetry or higher-order irregularity components (inflection points) were determined by using segmented regression analysis for each analysis diameter. RESULTS The pterygium advancement ranged from 2% to 57%, with a mean of 22.0%. Both components showed steep increases from the inflection points. The inflection points in the higher-order irregularity component altered with the analysis diameter (14.0%-30.6%), while there was no alternation in the asymmetry components (35.5%-36.8%). For the former component, the values at the inflection points were obtained in a range of 0.16 to 0.25 D. CONCLUSION The Fourier harmonic analyses for a series of analysis diameters revealed that the higher-order irregularity component increased with the pterygium advancement. The analysis results confirmed the precedence of corneal irregularity due to pterygium advancement.
Collapse
|