Pterygium Group Research Articles

COMPARISON OF MUTANT P53 PROTEIN EXPRESSION IN PTERYGIUM GROUP WITH AND WITHOUT TRIAMCINOLONE ACETONITED INJECTION

Background: Mutant p53 protein is produced by mutant p53 gene, this protein takes part in tissue hyperplasia process in pterygium. Triamcinolone acetonide in often use to reduce reccurency. Besides decreasing the inflamation triamcinolone acetonide is assumed to be able to repair the function of p53 gene. Thus, it reactivates cell apoptosis system and prevent the tissue hyperplasia process in pterygium.To compare Mutant p53 Protein Expression in Pterygium Group With and Without Triamcinolone Acetonide InjectionMethods: This research is a randomized clinical trial study consists of 31 subject who suffered primary pterygium. All subject divided into 2 grup with and without triamcinolone acetonide injection. After excision the pterygium and the tissue were examined through histopatology and immunohistochemical with Hematcoycline Eosin and reagent Clone DO7 staining to see the mutant p53 protein expression.Results: Mutant p53 protein expression in triamcinolone acetonite injected group is 0% and non triamcinolone acetonite injected group is 33,33%Conclusion: Mutant p53 protein expression in triamconolone acetonite injected group is lower than non injected grou.
 Keywords: Mutant p53 protein, primary pterygium, triamcinolone acetonide immunohistochemicial

Efficacy and Safety of Bevacizumab in the Treatment of Pterygium: An Updated Meta-Analysis of Randomized Controlled Trials.

Purpose Studies investigating efficacy and safety of bevacizumab in pterygium have increased and reported controversial results. Thus, we updated this meta-analysis to clarify the issue. Methods Studies were selected through search of the databases Embase, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) from their inception up until June 2017. The pooled risk ratio (RR) and 95% confidence interval (CI) were calculated for recurrence and complication rates by using random effects model. Results 1045 eyes in 18 randomized controlled trials (RCTs) enrolled. Overall, the pooled estimate showed a statistically significant effect of bevacizumab on the reduction of recurrence (RR 0.74, 95% CI 0.56–0.97, P=0.03). Subgroup analyses presented significant results beneficial to bevacizumab (primary pterygium group, RR 0.53, 95% CI 0.33–0.83, P=0.006; conjunctival autograft group, RR 0.48, 95% CI 0.25–0.91, P=0.02; and follow-up longer than 12 months group, RR 0.36, 95% CI 0.13–0.99, P=0.05). No statistically significant difference was observed in complication rates. Conclusions Application of bevacizumab showed a statistically significant decrease in recurrence rate following removal of primary pterygia, or in cases with conjunctival autograft, or with follow-up longer than 12 months, while complications were not increased.

Essential role of ultraviolet radiation in the decrease of corneal endothelial cell density caused by pterygium.

To investigate the essential role of ultraviolet (UV) radiation in the decrease of corneal endothelial cell density (ECD) caused by pterygium. In this retrospective controlled study, 76 consecutive patients with unilateral primary pterygium were enrolled from January 2016 to August 2016. The Central corneal ECD was measured in both eyes. Divide the subjects into two subgroups according to the UV exposure time, and the difference of corneal ECD between both eyes was analyzed using independent samples t-test. The relationship between the percentage of difference of corneal ECD and the disease duration, the percentage of pterygium to the cornea and the astigmatism value were analyzed. For subjects with longer UV exposure, the average of ECD in pterygium group and control group were, respectively, 2264.83 ± 349.78 cells/mm2 and 2477.16 ± 300.36 cells/mm2 (P = 0.004). For subjects with short UV exposure, the average of ECD in pterygium group and control group were, respectively, 2596.46 ± 373.24 cells/mm2 and 2690.66 ± 321.34 cells/mm2 (P = 0.262). The decrease of corneal ECD was positively correlated with the period of the disease (P = 0.035). There was no statistical correlation between a decrease in the corneal ECD and the percentage of pterygium to cornea (R = -0.055, P = 0.635) and the astigmatism value in the pterygium eye (R = -0.135, P = 0.246). UV radiation exposure played a significant role in the effect of pterygium decreasing the corneal ECD.

Expression changes and significance of ATP-binding cassette transporter B5 in pterygium

Background Limbal stem cells (LSCs) deficiency leads to many ocular surface diseases, such as pterygium and so on.ATP-binding cassette transporter B5 (ABCB5) is a recently discovered marker of LSCs.Understanding the expression changes of ABCB5 in pterygium tissue has an important clinical significance for pterygium. Objective This study was to investigate the expression changes of ABCB5 in pterygium tissue. Methods Thirty-seven pterygium tissue specimens were collected from primary pterygium patients who received pterygium surgery, and 22 normal conjunctival tissue specimens were obtained from the strabismus patients and retinal detachment patients during surgery in 474 Hospital of Chinese PLA from January 2015 to November 2015.Immunochemistry was employed to detect the expression and location of ABCB5 in the specimens, and the protein and mRNA expressions of ABCB5 were detected by Western blot and real-time fluorescence quantitative PCR, respectively.The results were compared between normal conjunctival tissues and pterygium tissue. Results ABCB5 protein was expressed in the cytoplasm and nuclei of stratified squamous epithelium of 22 normal counjunctival tissue specimens, especially in the basal layer cells, and showed obvious polarity in normal conjunctiva.In pterygium group, ABCB5 protein was positively expressed in 91.89% specimens (34/37) and the expression was absent in 8.11% specimens (3/37). The relative expression levels of ABCB5 protein were 0.90±0.31 and 0.59±0.41, and those of ABCB5 mRNA were 1.01±0.26 and 0.65±0.32 in the normal conjunctival tissues and pterygium tissue, respectively, showing significant differences between them (protein: t=-0.266, P=0.011; mRNA: t=-4.560, P=0.000). Conclusions Down-regulation of ABCB5 in pterygium indicates the decreasing and losing of LSCs, which may play an important role in the development of pterygium.ABCB5 may be a useful indicator for the prediction of development and recurrence of pterygium and has an important implication for treating evaluation, and it may also be a target for the management of pterygium. Key words: ATP-binding cassette transporters; Biomarkers/metabolism; Corneal limbus/cytology; Stem cells; Pterygium/pathology

Vitamin D and vitamin D receptor in patients with ophthalmic pterygium.

Pterygium, an ultraviolet radiation (UV)-related disease, is a relatively benign process, but since it displays tumor-like features, it has been proposed to be a neoplastic- like growth disorder. Vitamin D performs a number of functions in addition to calcium homeostasis, as inhibition of cell proliferation, activation of apoptotic pathways, and inhibition of angiogenesis. Since the antitumor actions of vitamin D are mediated primarily through the nuclear vitamin D receptor (VDR), the aim of the present study was to investigate vitamin D status in patients with pterygium and in control subjects, and VDR immunohistochemical expression in samples of pterygium and normal conjunctiva in order to evaluate a possible role of vitamin D pathway in the pathogenesis of the disease. Serum vitamin D concentration was measured among 41 patients with pterygium and 47 volunteers by an automated chemiluminescence immunoassay. Moreover, 23 formalin- fixed and paraffin-embedded pterygium biopsy samples and 24 conjunctiva specimens were treated for the immunohistochemical demonstration of VDR using the streptavidin-biotin alkaline phosphatase method. No differences were observed about vitamin D level between patient with pterygium and control group, but significant differences between VDR immunolocalization in pterygium and normal conjunctiva were observed (P=0.00001). In conjunctiva, the immunoreactivity, localized mainly in cytoplasm of epithelial cells, may probably demonstrate VDR regulation of cell growth, differentiation, and apoptosis, while in pterygium VDR co-localization in the nucleus and cytoplasm of epithelial cells may indicate alternative nuclear pathways by which vitamin D might exert its antiinflammatory and anti-proliferative effects by the regulation of gene expression.

Role of MDM2 SNP309 gene mutation in pterygium: a pilot study

Introduction: Pterygium is a common, vision impairing ocular surface disease whose etiopathogenesis is not yet fully established. Several factors, including ultraviolet radiation, heat, dry climate, microtrauma due to dust particles, and viral infections have been attributed to play a role in its pathogenesis. Recent studies have suggested that ptergyium might have a neoplastic origin. MDM2 SNP309 mutation has been associated with various tumors, however, its role in the pathogenesis of pterygium is not known. Objectives: To study the association between MDM2 SNP309 mutation and pterygium. Materials and Methods: In the present study, 37 pterygium patients and 49 controls were screened for MDM2 SNP309 mutation. Peripheral venous blood samples were collected from the study participants and the genomic DNA was isolated. This genomic DNA was used for polymerase chain reaction (PCR) amplification of MDM2 SNP309 mutation using the following set of primers: forward 5’-CGGGAGTTCAGGGTAAAGG-3’ and reverse 5’-TCGGAACGTGTCTGAACTTG-3’. Results: In the pterygium group, the frequency of genotypes GG, GT and TT were 32.6%, 40.8% and 26.5%; whereas in the controls it was 27.0%, 35.1% and 37.8% respectively. There was no statistically significant difference between the two groups in the genotype frequency of MDM2 SNP309 polymorphism (p>0.05). Conclusions: The results showed no significant difference between the ptergyium patients and controls in the genotype frequency of MDM2 SNP309 polymorphism. Keywords: MDM2 SNP309 polymorphism, Polymerase chain reaction, Pterygium

Evaluation of Interleukin-17 and Interleukin-23 in Pterygium: Immunohistochemistry Study.

To compare the interleukin-17 (IL-17) and interleukin-23 (IL-23) positive cell counts between pterygium and normal conjunctiva. A case-control study. This study received ethical approval (NMRR Research ID 23957) and informed consent was obtained from all participants. It involved 20 participants with 20 samples of pterygium and 20 samples of normal conjunctiva that were obtained from the same eye of each participant. All the participants underwent history taking, slit lamp examination, and pterygium excision surgery. Both samples underwent immunohistochemistry procedure. Pretreatment procedure was conducted using heat-induced epitope retrieval with PT link, subsequently followed by EnVision FLEX staining procedure and incubation with anti‒IL-17 antibody and anti‒IL-23 antibody. Slides were examined in high-power fields (400x) for both samples in 3 different fields. Total positive stained cell counts in all 3 fields with IL-17 and IL-23 between pterygium and normal conjunctiva were analyzed by using Wilcoxon signed rank test. IL-17 positive cell counts for normal conjunctiva showed mean 196.10 ± 80.487 but for pterygium was 331.10 ± 108.416. As for IL-23, the mean for positive cell counts for normal conjunctiva was 62.10 ± 33.462 and IL-23 positive cell counts for pterygium showed mean 102.95 ± 41.378. Both IL-17 and IL-23 were significantly increased in pterygium compared with normal conjunctiva (P < 0.001). Both IL-17 and IL-23 were found to be significantly higher in the pterygium group than in the normal conjunctiva group with P < 0.001 by Wilcoxon signed rank test.

Vitamin D level in patients with pterygium.

To evaluate blood vitamin D level in patients with pterygium. This prospective study, compared 58 eyes of 58 healthy individuals (control group) with 63 eyes of 63 patients with pterygium (study group). Subjects were stratified by time spent indoors or outdoors. Participants were given comprehensive ophthalmic examinations; blood 25-hydroxyvitamin D (nmol/L) was assayed. Vitamin D level was significantly higher in men with pterygium than without it (p=0.020), but the difference was not significant in women (p=0.86). In the pterygium group, vitamin D level was significantly increased in participants with outdoor activity (p=0.010). In the control group, vitamin D levels did not differ significantly with indoor and outdoor activity (p=0.126). Vitamin D level in participants with pterygium was significantly increased only in men and in those with more outdoor activity.

The Influence of Chemokine CXCR4 and Cyclooxygenase-2 in the Recurrence of Pterygium

ABSTRACTPurpose: To investigate the role of CXCR4 and cyclooxygenase-2 in pterygium recurrence.Methods: A total of 18 primary and 9 recurrent pterygium samples were analyzed. Immunohistochemical staining using primary antibodies against cyclooxygenase-2 and CXCR4 was performed. The cyclooxygenase-2 and CXCR4 expressing cells were calculated separately on the epithelium and stroma. In addition, a correlation between the area of pterygium and CXCR4 and cyclooxygenase-2 levels was investigated.Results: In the primary pterygium group, cyclooxygenase-2 staining was more intense in the epithelium and more dominant in the stroma of the recurrence samples. The CXCR4 expression was more intense in the stroma of both groups. The highest CXCR4 expression was observed in the recurrent pterygium group. There was a strong correlation between the area of pterygium and CXCR4 and cyclooxygenase-2 of stroma.Conclusions: CXCR4 and cyclooxygenase-2 may play an important role in the recurrence of pterygium.

Primer ve Rekürren Pterjium Cerrahisinde Fibrin Doku Yapıştırıcısının Kullanımı

Objective: To evaluate and compare postoperative visual outcomes, complications and recurrence rates between patients with primary and recurrent pterygium operated by means of conjunctival autograft technique with fibrin glue. Material and Methods: Between March 2010 and May 2011, 72 eyes of 52 patients, [24 males (46%), 28 females (54%)], who had undergone pterygium operation with conjunctival autograft technique with fibrin glue were included in this study. Their medical records were examined retrospectively. Their mean age was 45.98±12.60 standard deviation (SD) (range 21-69) years. Thirty two of them (61%) had unilateral and 20 of them (39%) had bilateral pterygium. Twenty seven patients (52%) had primary (group 1) and 25 patients (48%) had recurrent pterygium (group 2). Results: The mean age was significantly lower in the second group (p=0.00). In terms of sex and laterality, there was no significant difference between two groups (p=0.680, p=0.270). The mean operation duration was significantly longer in the second group (p=0.042). The mean preoperative and postoperative best corrected visual acuities were not significantly different between the groups (p=0.573, p=0.110). In terms of postoperative complications and recurrence, there was no significant difference between two groups (p=0.530, p=0.905). Conclusion: The use of fibrin glue for attachment of conjunctival autografts is a safe technique and has low complication and recurrence rates. In recurrent pterygium group, the mean age was significantly lower and the mean operation duration was significantly longer. Complication and recurrence rates were low in both primary and recurrent pterygium groups and there was no significant difference between two groups.

Expressions of pentraxin-3 and tumor necrosis factor-α stimulated gene-6 proteins in fibroblasts of conjunctivochalasis patients

Background Conjunctivochalasis is an age-related inflammatory ocular surface disease manifesting redundant, loose conjunctiva folds.Studies showed that conjunctivochalasis often accompanies with inflammatory response, indicating that a variety of inflammatory cytokines are involved in pathogenesis of conjunctivochalasis. Objective This study attempted to investigate the expressions of pentraxin-3 (PTX-3) and tumor necrosis factor-α stimulated gene-6(TSG-6) proteins in fibroblasts of conjunctivochalasis. Methods The protocol was approved by Ethic Committee of Putuo Hospital affiliated Shanghai University of Traditional Chinese Medicine.Thirteen eyes of 13 patients with conjunctivochalasis, 16 eyes of 16 patients with age-related cataract and 16 eyes of 15 patients with pterygium were included in Putuo Hospital Affiliated to Shanghai University of Traditional Medicine from January, 2011 to June, 2012.The samples of conjunctival tissue were collected in the patients during surgery under the informed consent, and fibroblasts were cultured and passaged by explant culture method.Content of PTX-3 and TSG-6 proteins in cell supernatant was detected by ELISA. Results Translucent poor, dark black area was around the cell overflow.Cultured cells of third generation showed long shuttle type, uniform size, radiated out in all directions, and oval nuclei was sited in the cytoplasm, surrounded by varying the length of cross-linking of cell processes.The concentrations of PTX-3 protein in cell supernatant were (2 182.33±738.68)pg/ml in the conjunctivochalasis group, which were higher than (738.32±335.00)pg/ml in the age-related cataract group and (981.37±416.04)pg/ml in the pterygium group, showing a significant difference among the three groups (F=6.474, P=0.032). The contents of TSG-6 proteins in cell supernatant were (59.10±6.52)pg/ml, (53.99±11.16)pg/ml and (35.01±5.33)pg/ml in the conjunctivochalasis group, pterygium group and age-related cataract group, with a significant difference among the three groups (F=7.421, P=0.024), and contents of TSG-6 proteins in the age-related cataract group was lowest, however, no significant difference was found in the TSG-6 contents between the conjunctivochalasis group and the pterygium group (P>0.05). Conclusions Inflammatory reaction participates in the pathogenesis and development of conjunctivochalasis, up-regulation of PTX-3 and TSG-6 expression in fibroblasts might partakes in the pathogenesis of conjunctivochalasis. Key words: Conjunctival diseases; Fibroblasts; Tenon capsule; Cells, cultured; Enzyme-linked immunosorbent assay; Conjunctivochalasis; Anti-inflammatory agents

Human adenoviruses role in ophthalmic pterygium formation.

Background:Ophthalmic pterygium is a common benign lesion of unknown origin and the pathogenesis might be vision-threatening. This problem is often associated with exposure to solar light. Recent evidence suggests that potentially oncogenic viruses such as human papillomavirus and Epstein-Barr virus may be involved in the pathogenesis of pterygia. Expression of specific adenovirus genes such as E1A and E1B, which potentially have many functions, may contribute to their oncogenic activity as well as relevance to cellular immortalization.Objectives:For the first time, we aimed to investigate involvement of adenoviruses in pterygium formation.Patients and Methods:Fifty tissue specimens of pterygium from patients undergoing pterygium surgery (as cases), 50 conjunctival swab samples from the same patients and 10 conjunctival biopsy specimens from individuals without pterygium such as patients undergoing cataract surgery (as controls) were analyzed for evidence of adenovirus infection with polymerase chain reaction using specific primers chosen from the moderately conserved region of the hexon gene. Furthermore, β-globin primers were used to access the quality of extracted DNA. Data was analyzed using SPSS (version 16) software.Results:Of 50 patients, 20 were men and 30 women with mean age of 61.1 ± 16.9 years ranged between 22 and 85 years. All samples of pterygia had positive results for adenoviruses DNA with polymerase chain reaction, but none of the negative control groups displayed adenoviruses. The pterygium group and the control groups were β-globin positive. Direct sequencing of PCR products confirmed Adenovirus infection.Conclusions:Adenoviruses might act as a possible cause of pterygium formation and other factors could play a synergistic role in the development. However, further larger studies are required to confirm this hypothesis.

Prolidase Enzyme Activity in Conjunctiva and Pterygium Tissues.

BackgroundThe aim of this study was to determine prolidase activity in conjunctival tissue and its relationship with pterygium.Material/MethodsProlidase activity was measured in 23 pterygium and 25 healthy conjunctival tissues and the 2 groups were compared.ResultsProlidase enzyme activity could not be measured in either the healthy conjunctival or in pterygium tissues. The mean serum prolidase levels of the control and pterygium groups were 967.46±353.64 and 858.29±301.83, respectively. Statistically, there was no significant difference between the groups with regard to serum prolidase levels (p>0.05).ConclusionsIn conclusion, absence of prolidase activity in pterygium tissue indicates that there is no collagen turnover in this tissue. We may explain this finding with the elastin-rich structure of the conjunctiva.

Oxidant/antioxidant state in tissue of prymary and recurrent pterygium.

BackgroundPterygium is a disorder of the ocular surface induced by chronic exposure to UV-light. Abundant data is available from patients with primary pterygium, but scarce from those with recurrent pterygium. The present study aimed to explore the oxidant/antioxidant status in tissue of primary and recurrent pterigium in men and women.MethodsPathological tissue samples were taken during surgery on patients with primary and recurrent pterygium. Healthy conjunctive tissue samples were taken during cataract surgery. After homogenization of 77 tissue samples, evaluation was made of thiobarbituric reactive substances (TBARS), nitric oxide (NO), total antioxidant status (TAS) and the activity of the three main antioxidant enzymes: glutathione peroxidase, superoxide dismutase and catalase. Gender differences were evaluated.ResultsCompared to the control group, in the primary pterygium group there was an increase in NO and TAS, and a tendency to a decrease of all antioxidant enzymes, indicating an increase in non-enzymatic antioxidant activity. Compared to the control group, in the recurrent pterygium group there was a significant decrease in the level of TAS and antioxidant enzymes. A high positive correlation was found between most of measured parameters within the control group and the recurrent pterygium group, but not within the primary pterygium group. Compared to men, a significant difference was observed in the elevated NO level and low TAS level of women in the prymary pterygium group.ConclusionsThe diminished antioxidant defense in the recurrent pterygium group, possibly determined mainly by decreased non-enzymatic activity, supports the idea that oxidative stress plays an important role in the recurrence of this disorder.

Reconstruction of the limbal vasculature after limbal-conjunctival autograft transplantation in pterygium surgery: an angiography study.

We evaluated the angiographic features of the affected limbus in patients with pterygia and assessed limbal reconstruction outcomes after limbal-conjunctival autograft (LCA) transplantation in terms of vascular remodeling. We studied prospectively 31 eyes of 31 patients who underwent pterygium excision and LCA transplantation; 28 eyes of 28 normal participants served as controls. Anterior segment indocyanine green angiography (ICGA) was performed for each participant preoperatively and at 1 week, and 1 and 3 months postoperatively. The perioperative angiographic features of the pterygium were compared to those in normal eyes. The structural changes of the marginal corneal vascular arcades (MCAs) and LCA were quantitatively assessed postoperatively in terms of vascular density and lacunarity. Deteriorated MCAs that extended beyond the pterygium head were observed in the pterygium group. The pterygium had a dual blood supply from the conjunctival and episcleral circulations. In terms of limbal reconstruction, the engorged reperfusion vessels arose from the adjacent episcleral vessels along the limbus at 1 week postoperatively. The reconstructed MCAs had begun to appear at 1 month postoperatively and became apparent 3 months postoperatively in 26 (83.9%) of 31 eyes of the pterygium group, resulting in a successful clinical outcome. Higher vascular density and lower lacunarity were measured in the limbus and the graft at 3 months than at 1 month (P < 0.001 for all), which indicated fine reorganization of the reconstructed vessels. The pterygium had a dual blood supply, and the remodeling of the affected limbus and LCA continued up to 3 months postoperatively.

Tear osmolarity and tear film parameters in patients with unilateral pterygium.

The aim of this study was to evaluate the differences in tear osmolarity and tear film parameters between pterygium-affected and healthy fellow eyes. The study enrolled 65 patients with unilateral pterygium. Tear osmolarity, tear film break-up time (TBUT), Schirmer I test measurements, fluorescein corneal staining, and conjunctival redness were evaluated. The results were compared between pterygium-affected eyes and healthy fellow eyes of the same patient (controls). The pterygium thickness was measured using optical coherence tomography. We also evaluated the relationship between pterygium thickness and tear osmolarity and between TBUT and Schirmer I test results in eyes with pterygium. The mean tear osmolarity was 307 mOsm/L in pterygium-affected eyes and 294 mOsm/L in control eyes. The mean values of TBUT, Schirmer I test, corneal staining, and conjunctival redness scores were 10.3 ± 3.4 seconds, 14.8 ± 9.2 mm, 1.2 ± 1.1, and 0.9 ± 0.9 in the pterygium group, whereas the mean values were 12.3 ± 4.4 seconds, 16.2 ± 7.2 mm, 0.4 ± 0.8, and 0.4 ± 0.7 in the control group, respectively. Eyes with pterygium had significantly higher tear osmolarity levels, corneal staining, and conjunctival redness scores; and lower tear film TBUT and Schirmer I test values than eyes without pterygium (Wilcoxon signed rank test, P < 0.05). There was no significant correlation between pterygium thickness versus tear osmolarity, TBUT, and Schirmer I test values in eyes with pterygium (r = 0.159, 0.738, 0.321, respectively; P > 0.05). This study showed that pterygium is associated with tear hyperosmolarity and abnormal tear film function.

Association between the ACE insertion/deletion polymorphism and pterygium in Sardinian patients: a population based case–control study

ObjectiveThe purpose of the study was to examine whether the insertion (I) and/or deletion (D) polymorphism of ACE confers susceptibility to primary pterygium in Sardinian patients in a case–control study.Methods...

Bevacizumab in the Treatment of Pterygium

The aim of this study was to assess the efficacy and safety of bevacizumab in the treatment of pterygium and to mainly explore its effects on recurrence rate and complications. We searched MEDLINE, EMBASE, Web of Science, and Cochrane Central Register from the inception to July 2013 for relevant randomized controlled trials that examined bevacizumab therapy for pterygium. Data concerning study design, patient characteristics, treatment, and outcomes were extracted. The methodological quality of the studies included was assessed using the Jadad score. Relative risk (RR) was calculated for recurrence rate and complications. A total of 474 patients with 482 eyes in 9 randomized controlled trials were analyzed. The pooled estimate showed that bevacizumab had no statistically significant effect on preventing pterygium recurrence [RR 0.90, 95% confidence interval (CI) 0.77-1.07, P = 0.23]. None of the subgroup analyses yielded significant results in favor of bevacizumab (surgery group: RR 0.77, 95% CI 0.50-1.18, P = 0.23; nonsurgery group: RR 0.98, 95% CI 0.86-1.11, P = 0.76; primary pterygium group: RR 0.82, 95% CI 0.53-1.26, P = 0.36; recurrent pterygium group: RR 0.95, 95% CI 0.82-1.09, P = 0.44). There were no statistically significant differences in the complications between the 2 groups (RR 1.00, 95% CI 0.73-1.37, P = 1.00). However, the bevacizumab group was associated with a higher risk of developing subconjunctival hemorrhage (RR 3.34, 95% CI 1.07-10.43, P = 0.04). Topical or subconjunctival bevacizumab was relatively safe and well tolerated, but it had no statistically significant effect on preventing pterygium recurrence. A large-scale trial with a suitable dosage and a longer follow-up would be required to rule out the possibility of any treatment benefit.

Clinical Outcome of Autologous Cultivated Limbal Epithelial Transplantation Therapy for Patients with Ocular Surface Disease

Introduction: Cultivated Limbal Epithelial Cells Transplantation (CLET) has been proven effective in reconstructing cornea surface of Limbal Stem Cell Deficiency (LSCD). To better understanding the potential and risk of this treatment in our current setup, we conducted a phase I clinical trial and determined the outcome of cultivated limbal epithelial transplantation for Ocular Surface Disease (OSD). Methods: Prospective interventional trial was conducted in Hospital Kuala Lumpur, Malaysia. Fourteen eyes of 14 patients with limbal stem cells deficiency: chemical injury (6), advanced pterygium (4), advanced Vernal Kerato Conjunctivitis (VKC) (2), Persistent Epithelial Defect (PED) (1) and Ocular Cicatricial Pemphygoid (OCP) (1) were selected according to the inclusion/exclusion criteria. Autologous cornea limbal epithelial stem cells were cultured on human amniotic membrane and subjected to immunohistological staining for a panel of markers (ABCG2, cytokeratins (K) 3, K19, p63, involucrin, integrin α9 and K14). Cell sheets with epithelial morphology and growth area greater than 80% will be used for CLET. Two weeks later, the tissue was transplanted to the recipient eyes after superficial keratectomy. The patients were followed up for 1 year. Outcome measures were improvement of symptoms, an improvement in visual acuity, no conjunctivalisation and vascularisation and healed persistent corneal epithelial defect. Results: Ten patients (71.4%) had an improvement in visual acuity of at least two lines at 6 months and one year (p<0.05%). Thirteen patients (92.8%) had cornea epithelisation in 1 month. The patient with persistent epithelial defect (PED) healed in 3 months and the patient with ocular cicatricial pemphygoid (OCP) had recurrent cornea epithelial defect at 6 months and healed after one year. On slit lamp examination, eight patients (57.1%) had no cornea vascularisation in 6 months and 1 year (p<0.05%). Ten patients (71.4%) had no cornea conjunctivalisation in 6 months and 1 year (p<0.05%). Conclusions: Transplantation of cultivated autologous limbal epithelial cell can efficiently restore the cornea with improved vision. Patients with chemical injury, advance pterygium group had better outcome results.

Evaluation of Ocular Surface Temperature in Patients with Pterygium

Purpose: To investigate ocular surface temperature in eyes with pterygium and dry eye disease.Methods: Eighteen eyes of 18 patients with pterygium (group 1), 18 eyes of 18 patients diagnosed with dry eye disease (group 2), and 22 eyes of 22 healthy subjects with no signs of dry eye (group 3), were included in this prospective study. Schirmer's test I and II, and tear film break up time (BUT) were evaluated. Infrared thermal imaging (Tomey TG 1000, Tomey Corp, Nagoya, Japan) was used to study the temperature of the ocular surface. All measurements were performed by one examiner only.Results: No significant difference in temperature course over ten seconds of eye opening was present between groups 1 and 2 (p = 0.551). However, a significant difference was present between groups 1 and 3 (p = 0.001) and between groups 2 and 3 (p = 0.003). Comparing group 1 and group 2, statistically significant differences in Schirmer’s test I (p < 0.001) and II (p < 0.001) and BUT (p = 0.04) were present. There were also significant differences in Schirmer`s test I (p < 0.001) and II (p < 0.001) and BUT (p < 0.001) between group 2 and group 3. No significant difference in Schirmer’s test I (p = 0.785) and II (p = 0.871) was present between group 1 and group 3. However, a statistically significant difference in BUT was noted (p < 0.001).Conclusion: During sustained eye opening, a significant decrease in corneal surface temperature occurred in eyes with pterygium and dry eye disease. Thermography, in addition to other investigations, might be used to objectively identify dry eye symptoms in patients with pterygium. In addition to cosmetic appearance, increasing astigmatism, and expanding growth towards the center of the cornea, this new supplementary data may help to determine the proper time for intervention.