PTERYGIUM: Recent trends and perspectives—A review of pathogenesis and current management options

Abstract

Objectives: (1) To review literature on the current understanding of the nature and pathogenesis of pterygium. (2) To highlight the recent advances in the treatment of pterygium. Materials and Methods: Relevant subheadings were entered into PubMed search engine and 165 articles addressing our objectives were retrieved and reviewed. Results: Pterygium may be proliferative rather than degenerative in nature. There is a strong correlation with ultraviolet radiation. Genetic alterations occur, such as point mutations of proto-oncogenesis such as Kirsten-Ras and alterations in the expression of tumor suppressor genes (TSGs) (p53 or p63), alteration of matrix metalloproteinase in limbal and corneal tissues, ultraviolet radiation (UVR) genetically mediated expression of various cytokines, growth factors, and growth factor receptors. Oxidative stress may play a role, evidenced by the expression of certain proteins in pterygium tissues presumed to have a protective role against oxidative stress-induced apoptosis. High prevalence of human papilloma viruses (HPVs) in pterygium tissue samples suggests a possible role for HPV. Several techniques of surgery have evolved over time including the modified bare-sclera techniques, sliding, “merest sclera,” adjunctive therapies with mitomycin C, 5-fluorouracil, corticosteroids, conjunctival autograft, limbal autograft, amniotic membrane graft, use of fibrin glue, and subconjuctival injection of bevacizumab. Conclusion: Advances in the understanding of pterygium have led to emerging treatment options that may not only reduce recurrent rates, but may also enable the use of less invasive treatment methods. Recommendation: Ophthalmologists working in hot climates should update their knowledge on the current concepts in the pathogenesis and management of pterygium to obtain better results.