Expression of CD44, PCNA and E-cadherin in pterygium tissues

PURPOSE

Pterygium is a common ocular surface disease defined by fibrovascular conjunctival growth extending onto the cornea. However, its pathogenesis remains unclear. This study aimed to determine the role of CD44, proliferating cell nuclear antigen (PCNA), and E-cadherin in pterygium formation and recurrence.

METHODS

Sixty patients with pterygium participated in the study, and we collected conjunctival samples from 30 patients to form a control group. CD44, PCNA, and E-cadherin expressions in surgically excised pterygium were compared with tissue samples from the control group.

RESULTS

We observed that the percentages of CD44 and PCNA were statistically higher in the primary pterygium group and recurrent pterygium group than in the control group (P < 0.001 and P < 0.001, respectively). Conversely, E-cadherin values were statistically higher in the control group than in the primary and recurrent pterygium groups (P = 0.013 and P < 0.001, respectively).

CONCLUSION

Cell proliferation and cell adhesion factors may play important roles in the pathogenesis of pterygium.

Congenital pterygium with anterior segment dysgenesis: rare ocular manifestation in Rubinstein-Taybi syndrome

Pterygium is a benign, wing-shaped fibrovascular overgrowth of subconjunctival tissue that can encroach over the cornea. This condition usually occurs in individuals aged 20-40 years but is rarely seen in children. We report a case of an infant with Rubenstein-Taybi syndrome presenting with nebulo-macular corneal opacity and congenital pterygium. On examination under anaesthesia, bilateral infero-nasal nebulo-macular corneal opacity (6 × 5 mm) with a whitish pink tissue originating from nasal bulbar conjunctiva was noticed. The probe test was negative for this tissue. To the best of our knowledge, only two other cases of congenital pterygium have been reported in the literature. The presence of this anomaly supports the hypothesis of genetic factors having a role in the development of pterygium.

Incidence of ocular surface squamous neoplasia in pterygium specimens

OBJECTIVE

Pterygium and ocular surface squamous neoplasia (OSSN) have been recognized as likely related conditions and share similar risk factors such as ultraviolet radiation and chronic inflammation. The purpose of this study is to review the incidence of OSSN in pathology specimens sent as pterygium at a single tertiary centre between 2010 and 2022.

METHODS

This is a retrospective chart review of patients operated on for pterygium between 2010 and 2022 at the University of Montreal Health Centre. Data collected include baseline demographics, results of pathology specimen, and clinical information for cases diagnosed as OSSN on pathology.

RESULTS

A total of 1559 patients were operated on for a clinical diagnosis of pterygium between 2010 and 2022, of which 854 patients (55%) were male. A total of 1142 specimens had available pathology reports, and most of the specimens were consistent with pterygium on pathology (1105 of 1142; 97%). There was an unexpected finding of 3 cases of OSSN (3 of 1142; 0.3%). Other diagnosis besides pterygium were seen in 3% of specimens (34 of 1142), including nevus (n = 12), spheroidal degeneration (n = 3), pyogenic granuloma (n = 3), and lymphangiectasia (n = 2). The 3 cases of OSSN included an 81-year-old male of French-Canadian background, a 52-year-old male of South Asian background, and a 59-year-old female of French-Canadian background. The pathology was diagnosed as conjunctival intraepithelial neoplasia (CIN) grade 3, CIN grade 2, and CIN grade 2, respectively.

CONCLUSION

The finding of OSSN in pterygium is rare in our population but can be clinically difficult to distinguish. It is important to send all pterygium specimens for pathology.

Expression of placental growth factor, neuropilin-1, and neuropilin-2 in primary pterygium tissue

PURPOSE

The aim of this study was to evaluate the expression of placental growth factor (PLGF), neuropilin-1 (NP-1), and neuropilin-2 (NP-2) molecules in primary pterygium tissue compared with normal conjunctival tissue.

METHODS

The records of 42 patients who underwent excision surgery with autografts for primary pterygium (pterygium group) and 20 patients who underwent conjunctival nevus excision surgery (control group) in the same period were reviewed retrospectively. The samples obtained from the pterygium tissues in the pterygium group and the clean conjunctival tissues adjacent to the nevus in the control group were collected from the archive. Immunohistochemical stains of the primary antibodies-1/100 diluted PLGF, NP-1, and NP-2 (Abcam Cambridge Science Park, UK)-were applied to all groups. Staining intensities and the percentage of positive cells in epithelial, endothelial, stromal, and inflammatory cells were analyzed by an experienced pathologist.

RESULTS

The positivity rates of PLGF and NP-2 expression in epithelial, endothelial, stromal, and inflammatory cells were found to be higher in the pterygium group than in the control group (PLGF: p < 0.001, p < 0.001, p = 0.001, and p < 0.001, respectively; NP-2: p < 0.001 for all). Staining intensities for PLGF and NP-2 were higher in the pterygium group than in the control group (PLGF: p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively; NP-2: p < 0.001, p < 0.001, p = 0.001, and p < 0.001, respectively). However, no significant differences were found in any cell type in terms of NP-1 expression positivity rates (p = 0.730, p = 0.121, p = 0.524, and p = 0.624, respectively) or staining intensity (p = 0.716, p = 0.147, p = 0.147, and p = 0.780, respectively).

CONCLUSION

PLGF and NP-2 levels were found to be higher in pterygium tissue, while there was no difference in NP-1. These results indicate the possible roles of NP-2 and PLGF in primary pterygium.

Accurate detection and grading of pterygium through smartphone by a fusion training model

BACKGROUND/AIMS

To improve the accuracy of pterygium screening and detection through smartphones, we established a fusion training model by blending a large number of slit-lamp image data with a small proportion of smartphone data.

METHOD

Two datasets were used, a slit-lamp image dataset containing 20 987 images and a smartphone-based image dataset containing 1094 images. The RFRC (Faster RCNN based on ResNet101) model for the detection model. The SRU-Net (U-Net based on SE-ResNeXt50) for the segmentation models. The open-cv algorithm measured the width, length and area of pterygium in the cornea.

RESULTS

The detection model (trained by slit-lamp images) obtained the mean accuracy of 95.24%. The fusion segmentation model (trained by smartphone and slit-lamp images) achieved a microaverage F1 score of 0.8981, sensitivity of 0.8709, specificity of 0.9668 and area under the curve (AUC) of 0.9295. Compared with the same group of patients' smartphone and slit-lamp images, the fusion model performance in smartphone-based images (F1 score of 0.9313, sensitivity of 0.9360, specificity of 0.9613, AUC of 0.9426, accuracy of 92.38%) is close to the model (trained by slit-lamp images) in slit-lamp images (F1 score of 0.9448, sensitivity of 0.9165, specificity of 0.9689, AUC of 0.9569 and accuracy of 94.29%).

CONCLUSION

Our fusion model method got high pterygium detection and grading accuracy in insufficient smartphone data, and its performance is comparable to experienced ophthalmologists and works well in different smartphone brands.

High-throughput screening of transient receptor potential (TRP) channels in pterygium

PURPOSE

Pterygium is a hyaline degenerative disease of the conjunctiva characterized by the progression of fibrovascular connective tissue from the bulbar conjunctiva to the cornea. The mechanism of pterygium formation is still not fully understood. Transient receptor potential (TRP) channels are a group of ion channels with distinct characteristics. Recent indications suggest TRP channels may play a significant regulatory role in pterygium development, but previous studies have mainly focused on in silico analysis. Accordingly, in the present study, we aimed to decipher the expression signatures and role of TRP channels in pterygium development.

METHODS

The study encompassed a cohort of 45 patients matched for age and gender distribution, comprising 30 individuals with primary pterygium (PP) and 15 individuals with recurrent pterygium (RP). The control group consisted of unaffected conjunctival tissue obtained from the same set of patients. High-throughput screening of differentially expressed TRP channels in pterygium tissues was achieved with the help of Fluidigm 96.96 Dynamic Array Expression Chip and reactions were held in BioMark™ HD System Real-Time PCR platform.

RESULTS

Statistically significant increases were found in the expression of 21 genes, mainly TRPA1 (p = 0.021), TRPC2 (p = 0.001), and TRPM8 (p = 0.003), in patients with PP, and in TRPC5 (p = 0.05), TRPM2 (p = 0.029), TRPM4 (p = 0.03), TRPM6 (p = 0.045), TRPM8 (p = 0.038), TRPV1 (p = 0.01) and TRPV4 (p = 0.025) genes in RP tissues.

CONCLUSION

Collectively, TRP channel proteins appear to play pivotal roles in both the development and progression of pterygium, making them promising candidates for future therapeutic interventions in patients afflicted by this condition.

Evaluation of lymphotoxin-alpha in pterygium and diagnostic value in active and inactive pterygium states

To explore the correlation between tear LT-a, pterygium status, and dry eye indicators. We established a diagnostic model to evaluate active pterygium. A retrospective study was conducted between June 2021 and June 2023 on 172 patients, comprising 108 men and 64 women. The study analyzed LT-a and various ocular parameters in all participants. The data was collected using Excel software and analyzed using SPSS 25.0 statistical software and Medcalc. We made a nomogram diagnostic model to different diagnosed the state of pterygium. This study found that pterygium has progressive eye surface damage during the active state. There was no significant difference in dry eye indicators between the two groups. However, the concentration of LT-a in the active group was significantly lower than that in the inactive group (P < 0.001). We observed that increased pterygium grade corresponded to a worse ocular surface condition. In addition, LT-a was significantly positively correlated with disease duration, but negatively correlated with age, pterygium size, active pterygium state, and LLT value. The optimal intercept value for evaluating active pterygium in Lt-a was ≤ 0.49 dg/ml. We screened three variables for evaluating active pterygium through Single and Multiple regression analysis: LT-a grading, pterygium size, and congestion score. Finally, we made a reliable diagnostic nomogram model. Pterygium development triggers immune inflammation. Our model based on LT-a identifies active pterygium for personalized treatment options and new research directions.

The effect of pterygium on front and back corneal astigmatism and aberrations in natural-light and low-light conditions

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.

Prevalence of co-existent neoplasia in clinically diagnosed pterygia in a UK population

INTRODUCTION

Ocular surface squamous neoplasia (OSSN) and pterygia share risk factors and co-exist in only a minority of cases. Reported rates of OSSN in specimens sent as pterygium for histopathological analysis vary between 0% and nearly 10%, with the highest rates reported in countries with high levels of ultraviolet light exposure. As there is a paucity of data in European populations, the aim of this study was to report the prevalence of co-existent OSSN or other neoplastic disease in clinically suspected pterygium specimens sent to a specialist ophthalmic pathology service in London, United Kingdom.

METHODS

We performed a retrospective review of sequential histopathology records of patients with excised tissue submitted as suspected "pterygium" between 1997 and 2021.

RESULTS

In total, 2061 specimens of pterygia were received during the 24-year period, with a prevalence of neoplasia in those specimens of 0.6% (n = 12). On detailed review of the medical records of these patients, half (n = 6) had the pre-operative clinical suspicion of possible OSSN. Of those cases without clinical suspicion pre-operatively, one was diagnosed with invasive squamous cell carcinoma of the conjunctiva.

CONCLUSION

In this study, rates of unexpected diagnoses are reassuringly low. These results may challenge accepted dogma, and influence future guidance for the indications for submitting non-suspicious pterygia for histopathological analysis.

[Pterygium surgery with sutureless, glueless conjunctival graft: Preliminary study at the Centre hospitalier universitaire de Cocody in Abidjan]

PURPOSE

To optimize the pterygium management by delineating the role of sutureless, glueless conjunctival graft.

MATERIALS AND METHODS

This was a prospective cohort study carried out at the Centre hospitalier universitaire de Cocody between October 1st, 2021 and March 31st, 2022. It analyzed a series of 36 cases of stage I, II and III pterygium by Cornand's classification, who underwent surgery by a sutureless conjunctival graft technique without biological glue.

RESULTS

Demographically, 33.3% of our study population were between 30 and 40 years of age, with a mean of 47.86 years. The patients showed a female preponderance, 53%, with a male:female ratio of 0.89. At the clinical level, 75% of our population presented for ocular redness, 84% had a nasal pterygium, and 75% were stage 2. In terms of postoperative course and appearance, we observed 80.55% graft stability, 5.56% graft retraction, 2.78% graft displacement, and 11.11% graft loss. At the conclusion of follow-up, we noted an 8.33% recurrence rate.

DISCUSSION

The use of intraoperative blood ensures patient safety and postoperative comfort. This technique demonstrates satisfactory results with primary, nasal pterygia.

CONCLUSION

Conjunctival autograft without sutures or biological glue might be a very promising surgical alternative in the surgical treatment of pterygium.

Snatching: A modified cosmetic technique in pterygium surgery without using scalpel

AIM

To evaluate the cosmetic surgical outcomes of primary corneal pterygia excision using the avulsion (snatching) technique.

METHODS

A prospective, interventional study included twenty-five eyes of 25 patients with primary pterygium underwent excision were followed up for at least 6 months. In all patients, snatching (modified avulsion) technique was utilised to avulse the pterygium head off the corneal surface and remove any residual fibres by Colibri without need for keratectomy with a scalpel.

RESULTS

The study involved 25 eyes of 25 patients with an average age of 42.5±56.5 years. The mean follow-up was 6 months. One-week post-op, 8 patients (32%) reported they can tell which is the operated eye but looked untouched while 17 (68%) patients reported that the operated eye looked red but is accepted. Twenty patients (80%) reported some discomfort while the remaining 5 patients (20%) reported no discomfort. Cornea examination showed a clear cornea in 18 eyes (72%), 6 eyes (24%) had mild keratitis, and 1 eye (4%) had clouding at the surgical site. Over an average of six months post-op follow-up period, all the patients (100%) reported they cannot tell which eye had the surgery and none (0%) of them reported discomfort. Examination of the cornea was clear in 24 (96%) eyes, but 1 (4%) eye had mild keratitis.

CONCLUSION

Snatching (modified avulsion) technique was found to be effective, safe, and presents decent aesthetic appearance for the management of primary corneal pterygia when safety points are firmly followed.

Pterygium combined with corneal perforation: a case report

BACKGROUND

Pterygium is a common ocular surface disease. Pterygium combined with corneal perforation is rare.

CASE PRESENTATION

A 28-year-old female patient visited our outpatient clinic due to sudden onset of blurred vision and increased tearing in her left eye. The visual acuity was 1.0 OD and intraocular pressure (IOP) of 19.5 mmHg for the right eye with no significant abnormalities found in the anterior and posterior segments. The visual acuity of her left eye was 0.06, and IOP was 6.2 mmHg. A triangular vascular membranous tissue was seen in her left eye below the nose growing into the cornea and the pupil area was not touched. Slit-lamp examination revealed a tiny round corneal perforation in 8 o'clock position of the lesion area. Hospital diagnosis was given as pterygium combined with corneal perforation. The patient was treated with levofloxacin eye drops and autologous serum-based eye drops.

CONCLUSIONS

We report a rare case of pterygium combined with corneal perforation. Perforation is a very rare complication of pterygium. This patient received proper treatment and good result was seen. This article aimed to improve clinicians' understanding of pterygium.

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.

Pterygium-Derived Artifact Simulating an Intraocular Tumor With Ultrawide-Field Imaging

This case report describes an uncommon artifact of ultrawide-field imaging derived from a large pterygium, which mimicked an intraocular tumor.

The association of sun exposure, ultraviolet radiation effects and other risk factors for pterygium (the SURE RISK for pterygium study) in geographically diverse adult (≥40 years) rural populations of India -3rd report of the ICMR-EYE SEE study group

Purpose

To determine the prevalence and risk factors for pterygium in geographically diverse regions of India.

Methods

A population-based, cross-sectional multicentric study was conducted in adults aged ≥40 years in plains, hilly and coastal regions of India. All participants underwent a detailed questionnaire-based assessment for sun exposure, usage of sun protective measures, exposure to indoor smoke, and smoking. Detailed ocular and systemic examinations were performed. Pterygium was diagnosed and graded clinically by slit-lamp examination. Association of pterygium with sociodemographic, ophthalmological, and systemic parameters was assessed. Physical environmental parameters for the study period were estimated.

Results

Of the 12,021 eligible subjects, 9735 (81% response rate) participated in the study. The prevalence of pterygium in any eye was 13.2% (95% CI: 12.5%-13.9%), and bilateral pterygium was 6.7% (95% CI: 6.2–7.2). The prevalence increased with age (<0.001) irrespective of sex and was highest in those aged 60–69 years (15.8%). The prevalence was highest in coastal (20.3%), followed by plains (11.2%) and hilly regions (9.1%). On multi-logistic regression, pterygium was positively associated with coastal location (P<0.001), illiteracy (P = 0.037), increasing lifetime sun exposure (P<0.001), and negatively associated with BMI ≥25 kg/m2 (P = 0.009).

Conclusion

Pterygium prevalence is high in the rural Indian population. The association of pterygium with several potentially modifiable risk factors reflects its multifactorial etiology and provides targets for preventive measures.

Biomarkers in the Occurrence and Development of Pterygium

Pterygium is a kind of common conjunctival degeneration. The pathogenesis of pterygium is complex, and various biomarkers provide new targets for treatment and prognosis. Currently, the most common treatment for pterygium is surgical excision, but it is invasive risk and has a high recurrence rate. Since the development of sequencing, gene chip technology, and proteomics technologies has been rapid, research on the internal mechanism of disease has been facilitated. This review focuses on recent advances in the discovery of biomarkers from the fields of genetics, proteomics, and epigenetics and their likely functional mechanisms and clinical applications in pterygium.

Diffuse anterior and posterior scleritis with multiple iris granular deposits following pterygium excision

Surgically induced necrotizing scleritis has been reported after several types of ophthalmic surgeries; however, not many cases are reported following pterygium surgery (PS).

A 79-year-old woman underwent primary pterygium excision and conjunctival autograft transportation with mitomycin C in her left eye. 18 months postoperatively, diffuse anterior and posterior scleritis was noted; however, scleral necrosis was not apparent. Multiple granular deposits were observed on the surface of the iris. The deposits, aqueous humor, and vitreous were examined. Since there were no signs of infection or malignancy, the patient was diagnosed with scleritis with intraocular inflammation following PS.

Necrosis was accompanying at the surgical site in most cases of scleritis following PS. However, the scleral necrosis of the surgical site was not significant in our case. Posterior scleritis associated with PS has never been reported. This is the first report of anterior diffuse scleritis accompanied by posterior scleritis following PS.

Abbreviations: PS = pterygium surgery, SINS = surgically induced necrotizing scleritis, MMC = mitomycin C, ANCA = antineutrophil cytoplasmic antibody

Safety and efficacy of pterygium extended removal followed by extended conjunctival transplant for recurrent pterygia

PURPOSE

To study the safety and efficacy of pterygium extended removal followed by extended conjunctival transplant for recurrent pterygia.

METHODS

Thirty-three eyes of 33 subjects with recurrent pterygia were enrolled in this prospective case series study. Pterygium extended removal followed by extended conjunctival transplantation was performed in all subjects. One surgeon (WA) performed all surgeries. All subjects completed follow-up for at least 12 months and were evaluated for recurrence and complications.

RESULTS

The mean age of the participants was 41.2 ± 10.3 years (range 22-60), 7 females (21.2%). The mean duration of follow-up was 25.64 ± 9.24 months (range 12-43). Corrected distance visual acuity (decimal notation) improved from 0.69 ± 0.22 (range 0.2-1.0) at presentation to a 1-year postoperative value of 0.83 ± 0.2 (range 0.3-1.0). No recurrence was reported in all subjects throughout the follow-up period. Transient graft swelling was recorded in 14 cases (42.4%) and resolved in all cases by the first week. All patients developed variable degrees of transient postoperative diplopia that resolved completely by the first 6 weeks. Donor site granuloma developed in 4 cases (12.1%). Spontaneous resolution was observed in 3 cases, while in one case, surgical excision was performed 2 months after the procedure.

CONCLUSIONS

In this study of eyes with recurrent pterygia, pterygium extended removal followed by extended conjunctival transplant was found safe and effective with no recurrence and minimal postoperative complications.

Hydroxychloroquine treatment on SARS-CoV-2 receptor ACE2, TMPRSS2 and NRP1 expression in human primary pterygium and conjunctival cells

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen for coronavirus disease 2019 (COVID-19) pandemic. Its infection depends on the binding of spike protein to the host cell receptor angiotensin-converting enzyme 2 (ACE2), type II transmembrane serine protease (TMPRSS2) and neuropilin-1 (NRP1). Hydroxychloroquine has been applied as one of the COVID-19 treatment strategies. Here we aimed to evaluate hydroxychloroquine treatment on SARS-CoV-2 receptor expression in human primary pterygium and conjunctival cells and its potential influences. Expression of ACE2, TMPRSS2 and NRP1 proteins were found in the epithelial layer of both primary pterygium and conjunctiva tissues as well as in their isolated fibroblasts. High concentration of hydroxychloroquine treatment significantly reduced the viability of both primary pterygium and conjunctival cells. ACE2 protein expression was significantly decreased in both pterygium and conjunctival cells after hydroxychloroquine treatment. Hydroxychloroquine also reduced NRP1 protein expression in conjunctival cells. In contrast, TMPRSS2 protein expression showed slightly increased in conjunctival cells. Notably, ROS production and SOD2 expression was significantly elevated in both pterygium and conjunctival cells after hydroxychloroquine treatment. In summary, this study revealed the reduction of ACE2 and NRP1 expression by hydroxychloroquine in human primary pterygium and conjunctival fibroblasts; yet with the increase in TMPRSS2 expression and oxidative stress and decrease in cell viability. Implementation of hydroxychloroquine for COVID-19 treatment should be carefully considered with its potential side effects and in combination with TMPRSS2 inhibitor.

Comparison of Pterygium Recurrence Rates Between Attending Physicians and Supervised Trainee Residents

PURPOSE

To compare the recurrence rates after pterygium surgery performed by supervised trainee residents and attending physicians.

METHODS

This retrospective study included pterygium surgeries performed by trainee residents and attending physicians in an academic institution in South Texas in the years 2008 to 2019. All residents performed surgeries under direct supervision of an attending physician. Only primary pterygium cases with a minimum postoperative follow-up of 6 months were included. Patients' demographics, primary surgeon, use of conjunctival autograft (CAU) or amniotic membrane graft (AMG), recurrence of pterygium, follow-up length, and complications were recorded.

RESULTS

This study included 240 eyes of 229 patients with a mean age of 55.6 ± 12.3 years (range, 28-91 years). Of these eyes, 100 surgeries were performed by attending physicians (including 87 with CAU and 13 with AMG) and 140 surgeries by trainee residents (including 119 with CAU and 21 with AMG). There were no significant differences between the 2 groups of patients regarding age, sex, and surgical technique (CAU vs. AMG). Patients were followed up for an average of 19.8 ± 15.2 months. No statistically significant differences were found in comparing the rate of pterygium recurrence between attending physicians and residents when using CAU (6.8% vs. 10.0%, respectively; P = 0.42) and AMG (69.2% vs. 47.6%, respectively; P = 0.22). Moreover, there were no significant differences in other postoperative complications between the groups.

CONCLUSIONS

Pterygium recurrence rates were similar between attending physicians and supervised trainee residents. Thus, acceptable outcomes can be expected when pterygium surgery is performed by a supervised ophthalmology resident.

Association between HPV detection in swab samples and tissue specimens and ophthalmic pterygium recurrence

PURPOSE

To investigate the presence of HPV on the ocular surface after surgical excision of HPV infected pterygia and the possible correlation of HPV with pterygium postoperative recurrence.

MATERIALS AND METHODS

Both exfoliative pterygium swab samples and respective tissue specimens were received and analyzed with real-time PCR for the detection of HPV-infected pterygia. In addition, swab samples from patients that had HPV-infected pterygia with no recurrence after 1 year of follow-up, as well as swab samples from patients with healthy conjunctiva, were analyzed.

RESULTS

Forty eyes with pterygium of 40 patients and 40 eyes with normal conjunctiva were included in the study. HPV virus was detected in the tissue specimens of 11 patients (27.5%) and in the swabs of 9 patients (22.5%). The HPV subtypes detected were 33, 39, 45, 56, 59, 66, and 68. The swab test had sensitivity of 81.82% and 100% specificity. In 15 (43%) patients, a bare sclera technique was used for pterygium removal and eleven of these patients showed recurrence of the disease. Surgical excision with use of autologous conjunctival graft was performed in twenty patients and five of them had recurrence. Patients with recurrent disease were 12.41 times more likely to have an HPV-infected pterygium (p = 0.031). Furthermore, from the 11 HPV positive patients, six had no recurrence, 1 year after surgery. In five of them, a swab sample was taken from the site of the surgical excision 1 year after surgery and real-time PCR was negative for HPV presence.

CONCLUSION

Persistence of HPV infection seems to be correlated with postoperative pterygium recurrence. Further investigation with the use of the minimally invasive proposed swab technique may contribute in the understanding of pterygium pathogenesis and in the development of a more efficient treatment planning.

Development of a valid and reliable pterygium surgery assessment scale for ophthalmology residents

BACKGROUND

Microsurgery training has become an important part of ophthalmology teaching and one of the main topics of examination. Accurate and effective evaluation of microsurgery skills is vital for the training and teaching of residents. In this study, we aimed to establish a pterygium surgery assessment scale for use by ophthalmic residents and evaluate its reliability and validity.

METHODS

Based on a literature search, experienced pterygium surgeons developed the preliminary scale according to the standard surgical procedure. The preliminary scale and a questionnaire were sent to teaching and research experts in the field for feedback. Face and content validity and reliability of the scale were determined by rounds of modifications based on expert feedback. For construct validity, existing assessment scales were obtained and a range of factors were tested.

RESULTS

Nineteen expert surgeons completed the questionnaire and modifications were made until all surgeons agreed on the final scale. Good construct validity was found by evaluation against 257 existing scales. For reliability, 280 evaluation scales were completed. Inter- and intra-rater reliability analysis both found Intraclass Correlation Coefficient (ICC) > 0.8 for all items and total scores.

CONCLUSION

The pterygium surgery assessment scale developed in this study has good reliability and validity, and is an effective measurement tool for the evaluation of ophthalmology residents' pterygium surgical skills.

Actinic Granuloma of the Conjunctiva: Case Series and Review of the Literature

PURPOSE

To characterize the clinical and histopathologic features of actinic granuloma of the conjunctiva.

DESIGN

Retrospective observational case series METHODS: Institutional pathology records between 2014 and 2020 were searched for all cases of conjunctival actinic granuloma. Information collected included age, sex, ocular and medical history, clinical findings, laboratory workup, treatment, follow-up, pathologic diagnosis, and histopathologic inflammation pattern.

RESULTS

Eight eyes of 8 patients, 5 men and 3 women, with a median age of 43 years (mean 49, range 24-83) were identified. Clinical diagnosis was pterygium (n = 4, 50%), inflamed pterygium (n = 1, 13%), pterygium vs conjunctival squamous cell carcinoma (n = 1, 13%), episcleritis vs inflamed pinguecula (n = 1, 13%), and scleritis vs keratoacanthoma (n = 1, 13%). Of 5 lesions with follow-up information, none recurred following excision with a median follow-up of 9 weeks (mean 19 weeks, range 1-61 weeks). Allergy/atopy was documented in 4 of 7 (57%) patients with available medical information. There were no other systemic associations. Histopathologically, actinic granuloma was associated with pterygium (n = 6, 75%) and pinguecula (n = 2, 25%). All lesions were composed predominantly of histiocytes and a variable number of foreign body-type giant cells associated with a focus of severe actinic elastosis. The inflammatory pattern was giant cell (n = 4, 50%), sarcoidal (n = 2, 25%), histiocytic (n = 1, 13%), and combined histiocytic and sarcoidal (n = 1, 13%).

CONCLUSION

Conjunctival actinic granuloma has diverse clinical and histopathologic manifestations, which need to be distinguished from other autoimmune, neoplastic, and infectious etiologies. This lesion frequently occurs in pre-existing pterygium and pinguecula and may be associated with allergy and atopy.

A deep transfer learning framework for the automated assessment of corneal inflammation on in vivo confocal microscopy images

Purpose

Infiltration of activated dendritic cells and inflammatory cells in cornea represents an important marker for defining corneal inflammation. Deep transfer learning has presented a promising potential and is gaining more importance in computer assisted diagnosis. This study aimed to develop deep transfer learning models for automatic detection of activated dendritic cells and inflammatory cells using in vivo confocal microscopy images.

Methods

A total of 3453 images was used to train the models. External validation was performed on an independent test set of 558 images. A ground-truth label was assigned to each image by a panel of cornea specialists. We constructed a deep transfer learning network that consisted of a pre-trained network and an adaptation layer. In this work, five pre-trained networks were considered, namely VGG-16, ResNet-101, Inception V3, Xception, and Inception-ResNet V2. The performance of each transfer network was evaluated by calculating the area under the curve (AUC) of receiver operating characteristic, accuracy, sensitivity, specificity, and G mean.

Results

The best performance was achieved by Inception-ResNet V2 transfer model. In the validation set, the best transfer system achieved an AUC of 0.9646 (P<0.001) in identifying activated dendritic cells (accuracy, 0.9319; sensitivity, 0.8171; specificity, 0.9517; and G mean, 0.8872), and 0.9901 (P<0.001) in identifying inflammatory cells (accuracy, 0.9767; sensitivity, 0.9174; specificity, 0.9931; and G mean, 0.9545).

Conclusions

The deep transfer learning models provide a completely automated analysis of corneal inflammatory cellular components with high accuracy. The implementation of such models would greatly benefit the management of corneal diseases and reduce workloads for ophthalmologists.

Efficacy of second donor conjunctival graft from the same site for pterygium - A retrospective analysis

Purpose

To know the efficacy of the second donor conjunctival graft from the same site as that of the previous donor area in pterygium treatment.

Methods

Case record of patients were retrospectively analysed and those patients who had undergone pterygium excision previously, either for nasal or temporal pterygium excision and came with complaints of pterygium growth in opposite side of the bulbar conjunctiva in the same eye were included in the study. The patients with double head pterygium previously treated only over one side were also included. Total of 23 such patients were included in the study. The patients were followed up on post-operative day 1, 2 weeks, 6 weeks, 6 months and 1 year. The outcome measures like recurrence, graft edema, graft retraction, graft loss and other complications were noted in each follow up.

Results

Among the 23 patients included in the study 9 were male and 14 were female patients with a mean age of 44±7.2 years (range 24-57 years). On an average follow up period of 15±8.5 months, only 1 patient among 23 patients had recurrence (4.43%). Other complications noted were graft retraction in 4 eyes (17.4%), sub conjunctival hemorrhage in 8 eyes (34.8%) and graft edema in 11 eyes (47.8%). Only one patient presented with granuloma (4.34%).

Conclusion

The second conjunctival graft from the same site is safe and effective with encouraging results in indicated cases.

Optical coherence tomography angiography of perilimbal vasculature: validation of a standardised imaging algorithm

PURPOSE

To test the reliability and accuracy of a standardised non-invasive imaging algorithm using optical coherence tomography angiography (OCTA) in detecting and quantifying pharmacologically induced changes in the perilimbal vasculature.

METHODS

In this prospective observational imaging study, 370 angiograms of 15 normal eyes and 10 eyes with nasal pterygiums were obtained using a commercially available OCTA system with split-spectrum amplitude-decorrelation angiography technology. Postprocessing of the images to quantify the area occupied by the blood vessels was performed using the Fiji software. The main outcome measures were reliability (intraobserver and interobserver agreement) and accuracy of the standardised algorithm in detecting and quantifying relative change (vasoconstriction and vasodilatation) in the area occupied by the blood vessels after instillation of topical vasoconstrictors.

RESULTS

The intraclass correlation coefficients for intraobserver and interobserver agreement were 0.91 and 0.88 (good to excellent), respectively. In normal eyes, significant vasoconstriction was noted at 5 min (35%-47%) after application of eye-drops, which peaked at 10 min (43%-63%) and was sustained until 20 min (35%-51%), followed by gradual recovery. Greatest effect was noted with a combination of 5% phenylephrine and 0.15% brimonidine tartrate (BT) eye-drops as compared with either one or two drops of BT alone, both at the 10 min (p=0.0058) and 20 min (p=0.0375) time points. This dose-dependent temporal trend was replicated in eyes with primary nasal pterygium (p=0.31).

CONCLUSIONS

The findings suggest that OCTA can reliably and accurately detect and quantify relative changes in the perilimbal vasculature in both normal eyes and in eyes with pterygium.

Application of autologous serum eye drops after pterygium surgery: a prospective study

PURPOSE

The study aims to determine the effect of 50% autologous serum drops (ASD) on corneal healing and patient comfort following pterygium surgery.

METHODS

Fifty eyes of 50 patients who underwent pterygium excision combined with autologous conjunctival graft were included in this prospective randomized study: in 25 eyes, 50% ASD. In the remaining 25 eyes, conventional artificial tears (CAT) were applied postoperatively until corneal epithelium had completely epithelialized. Corneal epithelium healing speed, visual analog scale (VAS) for postoperative pain assessment, conjunctival inflammation, and recurrences were evaluated. Patients were followed up for 6 months.

RESULTS

Mean corneal epithelium closure time was 3.16 ± 0.37 days (range 3 and 4 days) in ASD group and 4.96 ± 0.84 days in CAT group (range 4 and 6 days), and the difference was statistically significant (p < 0.001). VAS scores were significantly lower in ASD group than CAT group in the first 5 days after surgery. In 9 of 50 eyes, moderate conjunctival inflammation continued 1 month: 4 (16%) in ASD group and 5 (20%) in CAT group (p = 0.713). In total, pterygium recurrence was seen in 5 (10%) eyes: 2 eyes (8%) in ASD group and 3 eyes (12%) in CAT group (p = 0.637).

CONCLUSION

ASD accelerated corneal epithelial healing following pterygium surgery. ASD group had lesser pain that was seem to be related with accelerated corneal epithelial healing.

Outdoor Air Pollution and Pterygium in Korea

We investigated relationships between outdoor air pollution and pterygium in Korean adults. This study includes 23,276 adults in population-based cross-sectional data using the Korea National Health and Nutrition Examination Survey 2008-2011. Pterygium was assessed using slit lamp biomicroscopy. Air pollution data (humidity, particulate matter with aerodynamic diameter less than 10 μm [PM₁₀], ozone [O₃], nitrogen dioxide [NO₂], and sulfur dioxide levels [SO₂]) for 2 years preceding the ocular examinations were acquired. Associations of multiple air pollutants with pterygium or pterygium recurrence after surgery were examined using multivariate logistic models, after adjusting for several covariates. Distributed lag models were additionally used for estimating cumulative effects of air pollution on pterygium. None of air pollution factors was significantly associated with pterygium or pterygium recurrence (each P > 0.05). Distributed lag models also showed that air pollution factors were not associated with pterygium or pterygium recurrence in 0-to-2 year lags (each P > 0.05). However, primary pterygium showed a weak association with PM10 after adjusting for covariates (odds ratio [OR] 1.23; [per 5 μg/m³ PM₁₀ increase]; P = 0.023). Aging, male sex, and greater sun exposure were associated with pterygium, while higher education level and myopia were negatively associated with pterygium (each P ≤ 0.001). Male sex and myopia were negatively associated with pterygium recurrence (each P < 0.05). In conclusion, exposure to higher PM10 levels was associated with primary pterygium, although this study observed no significant association between air pollution and overall pterygium or pterygium recurrence in Korean adults.

Successful Treatment of Traumatic Onychodystrophy and Associated Pterygium Unguis With Fractionated Carbon Dioxide Laser: Case Report and Review of the Literature

Onychodystrophy is a common, chronic malformation of the nail that is aesthetically displeasing and can signi cantly impact patient quality-of-life. Onychodystrophy can be associated with pterygium unguis that contributes to pain and appears as a V-shaped exten- sion of the proximal nail fold skin. Treatment options are limited, and topical or intralesional corticosteroids have minimal ef cacy and cause signi cant patient discomfort. Surgical revision of onychodystrophy is complex, and symptomatic or aesthetic improvements are difficult to achieve. There is limited published literature on laser treatment of noninfectious onychodystrophy or associated pterygium unguis. We present a case of a 68-year-old man with a 10-year history of painful traumatic onychodystrophy with associated pterygium unguis, who was successfully treated after three treatments of fractionated carbon dioxide (CO2) laser. Additionally, we review the medical literature on laser treatment of noninfectious onychodystrophy and pterygium unguis. To our knowledge, this is the first reported successful treatment of painful traumatic onychodystrophy and associated pterygium unguis using fractionated CO2 laser. We hope clinicians consider this treatment modality to relieve pain and improve aesthetics associated with traumatic onychodystrophy and associated pterygium unguis. We envision additional research investigating the mechanism of action of fractionated CO2 laser may con rm this treatment option for the management of traumatic onychodystrophy and associated pterygium unguis. <em>J Drugs Dermatol. 2016;15(11):1461-1464.</em>.

Positive Association between Blood 25-Hydroxyvitamin D Levels and Pterygium after Control for Sunlight Exposure

Purpose

To investigate the association between blood 25-hydroxyvitamin D levels and pterygium.

Methods

Korean National Health and Nutrition Examination Survey 2008–2011 were used for the present epidemiologic study. A total of 19,178 participants aged ≥ 30 years were evaluated for blood 25-hydroxyvitamin D levels and performed ophthalmic slit lamp examinations. Pterygium was considered as a growth of fibrovascular tissue over the cornea.

Results

The average blood 25-hydroxyvitamin D levels were 18.6 ng/mL, and prevalence of pterygium was 6.5%. The odds of pterygium significantly increased across blood 25-hydroxyvitamin D quintiles after controlling sun exposure time as well as other confounders such as sex, age, smoking, diabetes, hypertension (P < 0.001). The odds ratios (OR) for pterygium was 1.51 (95% Confidence Interval[95%CI]; 1.19–1.92) in the highest blood vitamin D quintile. Stratified analysis by sex showed a positive association between blood 25-hydroxyvitamin D levels and pterygium in both men (quintile 5 versus 1, OR; 1.68, 95%CI; 1.19–2.37) and women (quintile 5 versus 1, OR; 1.37, 95% CI; 1.00–1.88).

Conclusions

Even after controlling sun light exposure time, we found a positive association between blood 25-hydroxyvitamin D levels and pterygium in a representative Korean population. The mechanism underlying this association is unknown.

Predictability of Intraocular Lens Power Calculation After Simultaneous Pterygium Excision and Cataract Surgery

This study was aimed to assess the predictability of intraocular lens (IOL) power calculation after simultaneous pterygium excision and phacoemulsification with IOL implantation. We retrospectively reviewed the clinical charts of 60 eyes of 60 consecutive patients (mean age ± standard deviation, 73.5 ± 7.0 years) who developed pterygium and cataract. We determined visual acuity (logMAR), manifest spherical equivalent, manifest astigmatism, corneal astigmatism, and mean keratometry, preoperatively and 3 months postoperatively. Corrected visual acuity was significantly improved from 0.19 ± 0.20 preoperatively to -0.06 ± 0.07 postoperatively (P < 0.001, Wilcoxon signed-rank test). Uncorrected visual acuity was also significantly improved from 0.62 ± 0.33 preoperatively to 0.31 ± 0.32 postoperatively (P < 0.001). At 3 months, 48% and 82% of the eyes were within ± 0.5 and ± 1.0 D, respectively, of the targeted correction. We found significant correlations of the prediction errors with the changes in the mean keratometry (Spearman signed-rank test, r = -0.535, P < 0.001) and with the pterygium size (r = -0.378, P = 0.033). Simultaneous pterygium and cataract surgery was safe and effective, and the accuracy was moderately predictable. However, it should be noted that a significant myopic shift occurred postoperatively, possibly resulting from the steepening of the cornea after pterygium removal, especially when the size of pterygium was large.

Precorneal tear film in pterygium eye

BACKGROUND

Symptoms of pterygium are similar to dry eye symptoms such as dryness and irritation. Precorneal tear film may be changed in pterygium eye.

OBJECTIVE

To evaluate tear breakup time and Schirmer's test results in patients with unilateral pterygium, and to find whether tear breakup time and Schirmer's test results were related to the size of pterygium.

MATERIAL AND METHOD

Ninety-two patients, aged between 29 and 78 years, were enrolled in this study. The size of pterygium was measured from limbus to apex of pterygium on a horizontal axis. Tear breakup time and Schirmer's test results were compared in pterygium eye and contralateral normal eye of the same patient. The paired t-test was used for calculating the difference. The Pearson correlation was used to assess the correlations of tear breakup time and Schirmer's test with pterygium size.

RESULTS

The mean horizontal size of pterygium +/- standard deviation was 2.1 +/- 0.7 millimeters. The mean +/- standard deviation of tear breakup time in pterygium eyes was 5.5 +/- 1.9 seconds compared with 11.3 +/- 2.7 seconds in contralateral normal eyes (t = 23.28, p < 0.001). The mean +/- standard deviations of Schirmer's test results in pterygium eyes and the opposite normal eyes were 9.8 +/- 3.9 and 10.0 +/- 3.9 millimeters, respectively (t = 1.43, p = 0.16). Both tear breakup time and Schirmer's test results had no correlation with pterygium size. The correlation coefficients between the size of pterygium and tear breakup time, and pterygium size and Schirmer's test results were 0.11 (p = 0.30) and 0.03 (p = 0.77), respectively.

CONCLUSION

The size of pterygium does not correlate with tear breakup time and Schirmer's test results. A decrease in tear breakup time, but normal Schirmer's test results, could be found in pterygium eyes.

Young patient's age determines pterygium recurrence after surgery

BACKGROUND

It is not clear whether demographic or pterygium characteristics or limbal stem cell deficiency determine pterygium recurrence after surgery.

PURPOSE

To determine whether the demographic, pterygium characteristics, or limbal stem cell deficiency determine pterygium recurrence after excision.

METHODS

Of 190 patients operated and followed-up for 6 months, 101 and 89 underwent free conjunctival autotransplant (CAT) or limbal conjunctival autotransplant (LCAT) respectively. The age, gender, occupation, grade of pterygium extent and degree of fleshiness, and laterality were compared between recurrent and no recurrent pterygia. Multivariate analysis was performed to determine the predictors of pterygium recurrence. Recurrence rates after surgery were compared between CAT and LCAT.

RESULTS

The age range of the 190 patients was 22-65 years, mean ±SD 46.4 ±10.8 years. Pterygium recurred in 52 (27.4%). Thirty-nine (75%) of 52 patients with pterygia that recurred were aged <50 years (young) vs. 72 (52%) of 138 young patients with no recurrence; odds ratio (OR) = 1.54; 95% confidence interval (95% CI) = 0.70-3.36; p = 0.28. Thirty-one (60%) of 52 participants with post-surgical recurrent pterygia had large pre-operative pterygium (grade ≥3) vs. 130 (94%) of 138 patients with large pterygia that did not recur; OR = 0.11; 95% CI = 0.04-0.28; p <0.001. Of 101 patients undergoing CAT, 29 (28.7%) experienced recurrence vs. 23 (25.8%) of 89 undergoing LCAT; p = 0.66.

CONCLUSIONS

Young age seems to be associated with pterygium recurrence after excision followed by conjunctival graft. Large pterygia were protective.

The association between pterygium and conjunctival ultraviolet autofluorescence: the Norfolk Island Eye Study

PURPOSE

To investigate the association between conjunctival ultraviolet autofluorescence (UVAF), a biomarker of ocular ultraviolet radiation (UVR) exposure, and prevalent pterygium.

METHODS

We conducted a cross-sectional study on Norfolk Island, South Pacific. All permanent residents aged ≥15 were invited to participate. Participants completed a sun exposure questionnaire and underwent autorefraction and slit lamp biomicroscope examination. Area of conjunctival UVAF (sum of temporal/nasal area in right and left eyes) was determined using computerized methods. Multivariate logistic and linear regression models were used to estimate the associations with pterygia and UVAF, respectively.

RESULTS

Of 641 participants, 70 people (10.9%) had pterygium in one or both eyes, and prevalence was higher in males (15.0% versus 7.7%, p = 0.003). Significant independent associations with pterygium in any eye were UVAF (per 10 mm(2)) [odds ratio (OR) 1.16, 95% confidence interval (CI) 1.16-1.28, p = 0.002], tanning skin phenotype (OR 2.17, 1.20-3.92, p = 0.010) and spending more than three-quarters of the day outside (OR 2.22, 1.20-4.09, p = 0.011). Increasing quartile of UVAF was associated with increased risk of pterygium following adjustment of age, sex and time outdoors (p(Trend) = 0.002). Independent associations with increasing UVAF (per 10 mm(2)) were decreasing age, time outdoors, skin type and male gender (all p < 0.001). UVAF area correlated well with the duration of outdoor activity (p(Trend) < 0.001).

CONCLUSION

Pterygium occurs in approximately one-tenth of Norfolk Islanders. Increasing conjunctival UVAF is associated with prevalent pterygia, confirming earlier epidemiological, laboratory and ray-tracing studies that pterygia are associated with UVR. Protection from the sun should be encouraged to reduce the prevalence of pterygium in the community.

Prevalence and clinicopathologic findings of conjunctival epithelial neoplasia in pterygia

PURPOSE

To study the prevalence of conjunctival neoplasia in clinically diagnosed pterygia and the clinicopathologic characteristics of conjunctival tissues obtained from pterygium excision.

DESIGN

Prospective, observational case series.

PARTICIPANTS

From February through August 2007, consecutive subjects indicated for pterygium excision were enrolled from an outpatient eye clinic of King Chulalongkorn Memorial Hospital, Bangkok, Thailand, and from the eye camp at the 6th Station of the Thai Red Cross Society, Aranyaprathet District, Sa Kaeo, Thailand. A total of 498 eyes from 482 subjects were studied. The mean age of the subjects was 56.5 ± 11.7 years. The male-to-female ratio was 3:7.

METHODS

Clinical data were gathered, including age, sex, occupation, family history, and medical history. Pterygia were clinically graded as mild, intermediate, or fleshy. Tissues from surgical fields were fixed in formalin and processed using standard pathology laboratory methods.

MAIN OUTCOME MEASURES

Histopathologic results were examined in a masked fashion by 3 pathologists.

RESULTS

Ninety-one percent of tissue was from primary pterygia. Most lesions were classified as intermediate grade (45.2%). Histopathologic results showed that 4 eyes had conjunctival intraepithelial neoplasia. Two eyes had minimal cellular atypia at the conjunctival epithelium. Two eyes had complex choristoma. For the subjects who had conjunctival epithelial neoplasia, the mean age was 57.0 ± 8.0 years, 44.4% were male, and none had a history of carcinoma in other organs or any history of herpes virus, human papilloma virus, or human immunodeficiency virus infections.

CONCLUSIONS

The prevalence of conjunctival epithelial neoplasia in clinically diagnosed pterygia is approximately 1.8%. Because the clinical characteristics of subjects who have conjunctival epithelial neoplasia apparently did not differ from those without, tissue pathologic examination may be required to diagnose the condition.

Spectral domain anterior segment optical coherence tomography assessment of pterygium and pinguecula

PURPOSE

To study the morphological patterns of pterygia and pingueculae using high-resolution anterior segment spectral domain optical coherence tomography (SD-OCT).

METHODS

Prospective cross-sectional study of 25 eyes presented with pterygia and pingueculae was conducted, and the eyes were examined by anterior segment SD-OCT.

RESULTS

We examined 25 eyes, including 13 eyes with primary pterygia, six eyes with recurrent pterygia, one case with a pseudopterygium and five eyes with pingueculae. Primary pterygia revealed elevation of the corneal epithelium by a wedge-shaped mass of tissue separating the corneal epithelium from the underlying Bowman's membrane, which became wavy and interrupted. We found satellite masses of pterygium tissue advanced under the epithelium beyond the clinically seen pterygium margins. In recurrent pterygia, we detected that the central tip of the pterygium was more advanced and creeping beneath the basal corneal epithelium than the primary pterygium. In pseudopterygium, the SD-OCT images showed that the overgrowing membrane was not really attached to the underlying cornea. In cases of pingueculae, SD-OCT revealed a wedge-shaped mass that was nearly similar in pattern to that of the pterygia but stopped at the limbal region. Immediately after removal of pterygia, we noticed many remnants of the pterygia masses over the corneal stroma in spite of the clinically clear appearance of cornea.

CONCLUSIONS

SD-OCT provided us with high-resolution images of the pterygium and the pinguecula and showed clearly the anatomical relationship between the corneal tissues and these lesions. The use of this new modality of imaging may help to decrease the current recurrence rates after pterygium excision through using the anterior segment SD-OCT in the evaluation of these lesions.

Comparative study of pterygium surgery

AIM

To compare and evaluate the success rates of various surgical techniques of pterygium excision, including pterygium excision with complete suture of conjunctivae (PESC), pterygium excision with conjunctival auto-graft transplantation with graft from the inferior temporal bulbar conjunctiva (ITBC) and pterygium excision with conjunctival auto-graft transplantation with graft from the superior temporal bulbar conjunctiva (STBC).

MATERIAL AND METHODS

120 cases with primary unilateral nasal pterygium were evaluated. Outcomes were evaluated in terms of complication and recurrence after pterygium excision. The patients were divided into 3 groups: 1. Group of 40 patients with primary pterygium (pterygium length over the cornea 1.0 mm and more) treated by the technique of pterygium excision with complete suture of conjunctiva (PESC). 2. Group of 40 patients with primary pterygium (pterygium length over the cornea 1.0 mm and more) treated by the technique of pterygium excision with the conjunctival autograft transplantation with graft from the inferior temporal bulbar conjunctivae (ITBC). 3. Group of 40 patients with primary pterygium (pterygium length over the cornea 1.0 mm and more) treated by the technique of pterygium excision with conjunctival auto-graft transplantation with graft from the superior temporal bulbar conjunctivae (STBC).

RESULTS

Mean follow-up time after the surgery was 15 months (6 to 24 months). 12 out of 40 (30%) recurred after the pterygium excision with complete suture of conjunctivae (PESC). Three out of forty (7.5%) pterygium recurred after the modified surgical techniques of pterygium excision with conjunctival auto-graft transplanttation with graft from the inferior temporal bulbar conjunctiva (ITBC). Five out of forty (10.2%) recurred after the pterygium excision with conjunctival auto-graft transplantation with graft from the superior bulbar conjunctivae (STBC). All the recurrences (8 cases) in both pterygium groups treated by the transplantation procedures were after excision of progressive pterygium when the pterygium reaches more than 3 mm of the corneae. One surgeon performed all 120 surgeries.

CONCLUSION

A comparison of the groups demonstrated that the recurrence rate was highest in the group without transplantation, using only complete suture of the conjunctiva. The excision of the pterygium with conjunctival auto-graft transplantation from the inferior or superior temporal bulbar conjunctiva are highly efficient in terms of low recurrence rates. The modified surgical technique using the graft from the inferior temporal bulbar conjunctivae is preferred because the superior bulbar conjunctiva is intact for eventual future surgical intervention.

[Pterygiun in a tropical region. Analysis of 344 cases in Cameroon]

PURPOSE

The aim of this study was to report the epidemiological, clinical and therapeutic aspects of pterygium in a Cameroonian population.

MATERIAL, METHODS

Over a period of three years, 344 patients (132 female, 212 males) with pterygium were recruited in a prospective study in the Eye Department of the University Teaching Hospital (UTHY).

RESULTS

The prevalence of pteygium among the consulted patients during this period was 1.28%. The mean age was 40 years and 92% of the patients were older than 30 years. The clinical forms were various with a predominance of quiet non progressive forms. The recurrences and the complicated forms were frequent among the patients whose occupation was linked to exposure of the ocular surface. With respect to therapeutical aspects, the excision of the lesion associated with a transplantation of the conjunctiva had greatly improved the results, with a rate of recurrence of 12%.

CONCLUSION

The treatment of pterygion should be adapted to individual cases. A long-term follow-up of surgical cases is advised. We recommend that the public could be informed on this pathology through the media and suggest that this study would be initiated in the sahelian region of the country in the future.

[Investigation of the impact of pterygium on ocular optic system aberration. Communication 2. New approaches to reducing aberrations during surgical treatment for pterygium]

The authors made a detailed comparative analysis of the aberration pattern of the cornea as a result of surgical treatment for pterygium, by applying various technologies. Forty-four patients (55 eyes) with primary Stages II to IV pterygium were examined. According to the surgical techniques, the patients were divided into 2 groups: (1) those in whom pterygium was surgically removed, followed by abrasive microsurgery and plastic repair with an autoconjunctiva (29 eyes) (a control group); (2) those who had undergone surgical pterygium removal, abrasive microsurgery, and plastic repair with an autoconjunctiva, followed by phototherapeutic eximer laser keratoablation (26 eyes). The study has revealed that phototherapeutic eximer laser ablation of the cornea after surgical excision and abrasive treatment of the corneal bed in Stages II to IV pterygium causes a considerable reduction in the level of aberrations of higher orders. The expedience of phototherapeutic keratoablation as part of multimodality treatment for Stages III and IV pterygium, which has been shown by the aberration analysis, is only one of the first steps in evaluating the efficiency of this technology of surgical treatment for pterygium. Studies involving an integrated clinicofunctional and ophthalmoergonomic assessment of this treatment technology should be continued, which makes it possible to evaluate the clinical efficiency of this procedure and to define a place of the presented technology in the surgical treatment of pterygium.

[Investigation of the impact of pterygium on ocular optic system aberration. Communication 1. Relationship of induced aberrations to the stage of pterygium]

The authors made a study in two areas: they investigated corneal aberrations in patients from different age groups in health; analyzed the corneal aberration pattern at different stages of pterygium in the matched age groups; and comparatively estimated values in pterygium and in health in the similar age groups. High-order aberrations (HOA) of the corneal were studied in 45 patients (84 eyes) aged 20 to 76 years. The corneal aberration pattern was analyzed in 44 patients (55 eyes) aged 25 to 74 years who had pterygium of different stages. The study covered patients with Stages II (24 eyes), III (n=20), and IV (n=11). The results of corneal HOA in health suggest that coma aberrations significantly increase with age while the rise of spherical aberrations is not decisive. Comparative analysis of aberrations in health and in pterygium of different stages showed that its stage II causes no significant changes in the corneal aberration pattern; the characteristic features of the latter in Stages III and IV pterygium are increases in trefoil and aberrations of the fourth and fifth orders: tetra- and pentafoil, secondary trefoil. The increase in the above parameters is proportional to the stage of pterygium. The comprehensive examination of patients with pterygium of different stages should comprise a study of corneal HOA, it is required for more detailed evaluation of disorders induced by the extent of pterygium, which in turn makes it possible to optimize the latter's removing technology.

Bartsocas-Papas syndrome

We report three sibs born to a third degree consanguineous Indian family affected with Bartsocas Papas Syndrome. All the three pregnancies were complicated by severe oligohydramnios, which is not commonly seen with Bartsocas-Papas syndrome.

Role of concanavalin A lectin in recognition of pterygium remnant after surgical excision: preliminary results of a prospective study

Background:

Pterygium is one of the most common conjunctival diseases among ophthalmic pathologies. The frequency of recurrences is high, either after surgical treatment or after treatment combined with mitomycin C or beta-radiation therapy.

Aims:

The purpose of this study was to determine whether concanavalin A (ConA) lectin bound to the pterygial surface can be used to detect recurrence or remnants of pterygium after surgical excision.

Materials and Methods:

This was a prospective study on 20 patients with pterygium, divided in five stages, pre-surgery, early post-surgery (24h), late post-surgery (seven days), very late post-surgery (four weeks) and two months after the procedure.

A drop of fluorescein-marked Con A (35 µg/mL) was instilled in the lower conjunctival eyelid sac and the eye was exposed to the light of a Wood′s lamp for an average of five seconds.

Results:

Out of the 20 patients, eight patients were found to have fluorescent stretch marks over the scar corresponding to residual pterygial tissue at four weeks; two months after the procedure of re-surgery we observed no fluorescent remnants. All residual pterygia were confirmed through histochemistry studies.

Conclusion:

It was possible to detect remnants of pterygium in postoperative patients and recurrences in early pre-clinical stages through the visualization of fluorescent ConA bound to the pterygial surface.

Prognosis-determinant candidate genes identified by whole genome scanning in eyes with pterygia

PURPOSE

To identify the genes that can differentiate primary from recurrent pterygia.

METHODS

The transcriptional differences of primary and recurrent pterygia were first determined by microarray analyses. Computational analyses were used to extract the biological significance of the genes accurately, and a significant functional classification of the genes was made by unsupervised methodologies. After confirming the functional classification for primary and recurrent pterygia by a clustering algorithm, a support vector machine (SVM) algorithm was applied. Based on a machine learning technique, the minimum number of genes that can accurately classify primary and recurrent pterygia was determined.

RESULTS

Clustering analyses classified primary and recurrent pterygia transcriptomes and identified 10 clusters associated with distinct biological processes. When the SVM algorithm was applied to the microarray-analyzed products from three primary and three recurrent cases, periostin, TIMP-2, and L-3-phosphoserine phosphatase homolog (PSPHL) were identified as the minimum set of predictors with 100% accuracy. A differential expression of these genes in primary and recurrent pterygia was confirmed by immunohistochemistry. When the 24 patients with primary disease and the 8 patients with recurrent disease were analyzed with this gene set, an accuracy of classification of 84.38% was achieved.

CONCLUSIONS

Periostin, TIMP-2, and PSPHL can be used as predictor genes for the recurrence of pterygia. Their biological activities may explain the events leading to recurrences of pterygia and thus may be genes to target for pharmaceutical interventions.

[Recurrence rates after pterygium excision with sliding conjunctival flap versus free conjunctival autograft]

BACKGROUND

After simple excision without additional surgical measures, pterygiums demonstrate high recurrence rates. According to the literature, recurrences may occur in up to 83% after simple excision compared to 5-21% after excision combined with conjunctival autografts. An alternative to the free conjunctival graft is the sliding conjunctival graft.

METHODS

The data of 50 patients operated over a period of 8 years were evaluated retrospectively. The long-term results after pterygium excision with free conjunctival graft vs sliding conjunctival flap were compared with data extracted from the literature.

RESULTS

The average follow-up was 23 months. During this period, 18.5% of 27 operated eyes with free conjunctival grafts developed a recurrence of pterygium. After excision with sliding conjunctival grafts only 6.9% of 29 operated and examined eyes developed recurrences.

CONCLUSION

In the present study pterygium excision combined with sliding conjunctival graft was a simplified surgical technique with a lower recurrence rate compared to the free conjunctival graft.

Early fetal akinesia deformation sequence: a case report with unusual autoptic features

In this paper we report a case of early onset fetal akinesia, with unusual pathological findings. This is a product of medical abortion of young, healthy, unrelated parents. The mother's obstetrical history revealed two previous early miscarriages and a suspicion of FADS in the second previous gestation. At 17 weeks of gestation, an ultrasound examination disclosed absence of fetal movements, fixed extended knees and deformation of the feet. Amniocentesis showed a normal 46, XX karyotype. Hydrops fetalis and multiple skin webs (pterygia), which are usually present in cases of early fetal akinesia, were absent. A diagnosis of arthrogryposis was made and the pregnancy was terminated at 17 weeks of gestation. Postmortem examination was performed according to the necropsy technique suggested by Langley. Thus, body weight and external measurement, including crown-rump, crown-heel, foot lengths, head, thorax and abdominal circumferences were estimated and compared with standard values for assessment of fetal growth. External dysmorphic features were evaluated prior to the evisceration. On internal examination the location and shape of every organ was evaluated. Every organ, skin, muscles from different parts of the body, the brain and spinal cord were sampled and histologically examined. External examination revealed a female fetus with marked muscular hypoplasia of upper and lower extremities with thin arms and legs and multiple joint contractures of lower extremities. The face showed a flattened nose, micrognatia, hypertelorism, cleft palate and low-set ears. There was also a small nuchal fold. The abdomen was distended with a very thin and almost transparent wall. Histologically, muscles were characterized by severe fibrosis with fatty infiltration and by moderate variability in diameter of muscle fibers. The spinal cord disclosed a paucity of anterior horn motor neurons. We suggest multiple pterygium as a diagnosis. Lethal multiple pterygium syndrome (LMPS) is only a symptom and the precise diagnosis is more likely to be spinal atrophy. We, moreover believe that the paucity of spinal motoneurons could be due to the anomalies of programmed death during fetal development and the consequence of genetic defects.