Occurrence Of Pterygium Research Articles

Impairment of autophagy promotes human conjunctival fibrosis and pterygium occurrence via enhancing the SQSTM1-NF-κB signaling pathway.

Pterygium is a common ocular disease with a high recurrence rate, characterized by hyperplasia of subconjunctival fibrovascular tissue. Autophagy, an important process to maintain cellular homeostasis, participates in the pathogenic fibrosis of different organs. However, the exact role of autophagy in pterygium pathogenesis remains unknown. Here, we found that autophagic activity was decreased in human pterygium tissues compared with adjacent normal conjunctival tissues. The in vitro model of fibrosis was successfully established using human primary conjunctival fibroblasts (ConFB) treated with transforming growth factor-β1 (TGF-β1), evidenced by increased fibrotic level and strong proliferative and invasive capabilities. The autophagic activity was suppressed during TGF-β1- or ultraviolet-induced fibrosis of ConFB. Activating autophagy dramatically retarded the fibrotic progress of ConFB, while blocking autophagy exacerbated this process. Furthermore, SQSTM1, the main cargo receptor of selective autophagy, was found to significantly promote the fibrosis of ConFB through activating the PKCι-NF-κB signaling pathway. Knockdown of SQSTM1, PKCι, or p65 in ConFB delayed TGF-β1-induced fibrosis. Overexpression of SQSTM1 drastically abrogated the inhibitory effect of rapamycin or serum starvation on TGF-β1-induced fibrosis. Collectively, our data suggested that autophagy impairment of human ConFB facilitates fibrosis via activating the SQSTM1-PKCι-NF-κB signaling cascades. This work was contributory to elucidating the mechanism of autophagy underlying pterygium occurrence.

Impact of pterygium on central corneal thickness measured by optical coherence tomography in older adults.

To measure the central corneal thickness (CCT) using anterior segment optical coherence tomography (AS-OCT) in older adults with and without pterygium from the Brazilian Amazon Region Eye Survey (BARES). BARES is a population-based epidemiological cross-sectional study conducted in Parintins city. Participants were residents ≥45 years of age identified through a door-to-door interview. Eligible participants were invited for a comprehensive eye exam. Pterygium occurrence and severity were assessed by ophthalmologists through slit-lamp examination considering its location (nasal or/and temporal) and severity (lesion with extension <3 mm, ≥3 mm not reaching the pupillary margin or ≥3 mm reaching the pupillary margin). CCTs were obtained and measurements from the more severely affected eye were included. Images were analyzed offline by masked observers. A total of 671 subjects, 533 (79.4%) with pterygium in at least one eye and 138 (20.6%) without pterygium in either eye, were examined. The mean CCT evaluated by multiple linear regression and adjusted for demographic variables and pterygium severity was 521 ± 34 μm (median = 521; range = 304-665). Decreased CCT was significantly associated with age and pterygium severity. Individuals aged 65-74 years had CCT 7 μm thinner than those aged 45-54 years (p = 0.044), individuals aged 75 years and older had CCT 15 μm thinner than those aged 45-54 years (p = 0.001), and eyes with severe pterygium had CCT 33 μm thinner than eyes without pterygium (p < 0.001). The CCT analysis in this population-based sample shows that a thinner cornea is associated with pterygium severity and older age.

Changes in TRPV1 Expression as Well as Substance P and Vasoactive Intestinal Peptide Levels Are Associated with Recurrence of Pterygium

Pterygium, a disease of the ocular surface, is characterized by the proliferation and invasion of fibrovascular tissue. Chronic inflammation contributes to pterygium occurrence. Sensory neuropeptides of TRPV1-positive nerve fibers are involved in inflammation and corneal wound healing. The possible association between TRPV1 in nerve fibers and neuropeptides such as Substance P (SP) and Vasoactive Intestinal Peptide (VIP) in the recurrence of pterygium has not been examined before. The pterygia from 64 patients were used to determine changes in SP and VIP levels using 10 min acetic-acid extraction that yielded mainly neuronal peptides. There was a sufficient amount of pterygium tissues from the 35 patients for further immunohistochemical analysis of TRPV1 and S100, which is a glial marker to visualize nerve fibers. SP and VIP levels increased markedly in cases with primary and secondary recurrences, and there was a close correlation between SP and VIP levels. TRPV1 expression increased in the epithelium, while stromal expression decreased in recurrences. Nerve fibers were demonstrated mainly in the stroma, and serial sections confirmed the localization of TRPV1 with the nerve fibers. These results together with previous findings demonstrated that the increased epithelial expression of TRPV1 in recurrent pterygia might be involved in the pathogenesis, and the inhibition of epithelial TRPV1 activity may prevent recurrence.

New factors of pterygium occurrence and recurrence after surgical treatment

Background. Occurrence and recurrence of pterygium after surgical treatment are still urgent problems of modern ophthalmology. The purpose was to determine the main factors leading to the occurrence and recurrence of pterygium after surgical treatment. Materials and methods. We observed 203 patients (232 eyes) with pterygium. There were 108 men and 95 women. The age of patients ranged from 35 to 65 years. The duration of the disease is 2.5–2.7 years. Patients underwent surgical treatment for pterygium by the McReynolds’ method forming a cul-de-sac, by the Artl method with its incision, and the McReynolds and Artl methods using 0.02% solution of mitomycin C. The patients were examined in 3, 6 months, and one year after surgery. The statistical analysis of the results of clinical trials was performed using the software package SPSS 11.0, MedStat (Lyakh Y.E., Guryanov V.G., 2004–2012), MedCalc (MedCalc Software bvba, 1993–2013). Results. The results of clinical studies have found that the frequency of pterygium recurrence after traditional surgical interventions by the McReynolds method, the McReynolds method using 0.02% solution of mitomycin C, by the traditional Arlt method, the Arlt me-thod using 0.02% solution of mitomycin C in 3 months was 20, 17, 15, and 8.7 %, respectively; in 6 months — 29.5, 27, 27, and 26 %, respectively; after 1 year — 26.5, 26.5, 30.6, and 37 %, respectively. Long-term recurrence of pterygium did not differ significantly (p &lt; 0.05). Viral infection was found in pterygium tissue in 50.9 % of cases, including herpesviruses (33.6 %) and human papillomavirus (HPV, 34.0 %). Among herpesviruses, herpes simplex virus (HSV) was found in 15.1 % of cases, cytomegalovirus (CMV) in 7.3 %, and Epstein-Barr virus (EBV) in 11.2 % of cases. The regression analysis showed an association of HSV with stage II and stage III pterygium (p &lt; 0.05). No such dependencies were found for CMV and EBV. There was a relationship of HPV with the I–III stages of pterygium (p &lt; 0.01). There were types 6 (34.2 %), 11 (24.1 %), 16 (21.5 %), and 18 (20.2 %) among HPV. Types 6 and 11 were mainly detected at the first stages and were not detected in stage IV; types 16 and 18 were not detected in stage I (p = 7.9e-04). Among other types, only HPV6 was associated with the I and III stages of pterygium (p &lt; 0.05). Double mixed infection was detec-ted in 32.1 % of patients. The most common was the combination of HSV and HPV (30.6 % of all cases of mixed infection), three viruses — in 2.5 % of cases in the combination of HSV + CMV + HPV and HSV + EBV + HPV. It was first established that the V600E mutation of the BRAF gene was detected in 35.3 % of cases of pterygium. No significant difference in mutation frequency depending on the sex and age of patients was found. The frequency of mutation by stages increased from 21.3 % at stage I to 57.7 % at stage IV (p = 0.0003). The regression analysis showed a strong progressive association with the presence of the BRAF gene V600E mutation with the pterygium stage and, therefore, its progression. Conclusions. Thus, it was proved that the presence of HSV, HPV, and mutation V600E of the BRAF gene significantly influenced the occurrence and progression of pterygium after surgical treatment.

Study of clinical profile and surgical outcome of pterygium in adult patients at rural tertiary care hospital.

Introduction: Pterygium is a benign, degenerative condition of the subconjunctival tissue, for which many surgical techniques ranging from McReynaud’s operation to conjunctival autograft and amniotic membrane graft, have been discussed in the literature. Grafts prevent a recurrence, acting as a barrier, and have proven to be the gold standard. Here we have studied the clinical profile and surgical outcome of pterygium surgery by various techniques at a Rural tertiary care hospital (RTCH). Aims/ Objectives: Our primary aim was to study demographical factors and clinical profile of pterygia along with the surgical outcome and postoperative complications of pterygium surgery by various techniques, at RTCH. Materials and Methods:&nbsp; In this, hospital-based observational descriptive longitudinal study, we studied 75 patients, with primary progressive pterygium, who underwent pterygium surgery from September 2019- March 2021 and recorded their pre-operative, intraoperative, and postoperative data with a follow-up period of 3 months. Results: 74.6% of the population were females, with a bimodal peak incidence in 31-40 years and 61-70 years (22.6%).&nbsp; Most common presentation in both eyes (46.6%) with 97.3% cases presenting with nasal pterygium. 66.6% of patients presented with a grade 2 pterygium. 50 patients had a pre-operative “with the rule astigmatism”. Pre-operative keratometry readings could not be assessed for 5 patients due to excessive distortion of the corneal surface. 37 patients underwent graft fixation with no suture no glue while 38 patients underwent graft fixation with sutures. The most common complication was graft edema which was seen in 53 patients, while recurrence was seen in 2 patients. Conclusion: The occurrence of pterygium is very common in rural areas, which in most cases, is neglected due to lack of awareness. Surgical excision with conjunctival autograft continues to be the gold standard of treatment for the same.

Pterygium: new insights

Pterygia are common conjunctival degenerations with well-documented risk factors but an unclear pathogenesis. Better understanding of the pathogenesis of pterygium could lead to improved surgical outcomes and decreased postoperative recurrence. Currently, pterygium excision with conjunctival autograft remains the preferred surgical technique to decrease pterygium recurrence. Many adjuvant therapies have been used in pterygium surgery to varying degrees of success. Topical cyclosporine, an immunosuppressive medication, in conjunction with conjunctival autograft was found to be most successful in decreasing pterygium recurrence according to a recent meta-analysis. Other adjuvant therapies such as mitomycin-C (MMC), 5-fluorouracil (5-FU), and beta-irradiation have also been used, though usage of these may cause multiple adverse effects. Recent research indicates that interactions between mouse double minute 2 (MDM2) and p53 could play a role in the occurrence of pterygium. Nutlin, anMDM2 antagonist, was found to have significantly less toxicity in conjunctival cells when compared with MMC on laboratory analysis of pterygium samples.

Epidemiologic study of pterygium in Taiwan

To investigate the incidence, prevalence, and factors related to pterygium in Taiwan. An ecological study METHODS: We analyzed a random sample of 1 million individuals in Taiwan drawn from the National Health Insurance Database (NHIRD), established in 2005, for the period 2000 to 2011. Patients with pterygium were identified using ICD-9-CM diagnostic codes. The prevalence and annual age- and gender-adjusted incidence of pterygium were calculated for each county in Taiwan. The risk factors including ultraviolet (UV) exposure, outdoor occupation, educational level, and average socioeconomic status of each county of each index year were identified. Univariate and backward elimination multivariate selection by the mixed-effects model were performed to identify significant risk factors related to the incidence of pterygium in Taiwan. A total of 22,063 individuals with pterygium (10,125 men and 11,938 women) were identified in this study. The prevalence of pterygium was 2.14% in the overall population and 3.48% in the population aged 40years or older. The occurrence of pterygium was greater in women. In addition, this study demonstrated that UV exposure and low educational level are correlated with the age- and gender-adjusted incidence of pterygium. Our study is the first to use the NHIRD to determine the prevalence (2.14%) and annual age- and gender-adjusted incidence of pterygium among the general population of Taiwan. The relationship of pterygium with UV exposure and educational level suggests a complex and multifactorial etiology for this disease.

Face shield (or helmet) as protection against pterygium among motorcycle taxi drivers in DKI Jakarta

Pterygium is a triangular form of fibrovascular tissue growing from the conjunctiva to the cornea in the interpalpebral region. Motorcycle taxi drivers are at risk for pterygium development due to factors including ultraviolet exposure, chronic dust irritation, and wind. The aim of the present study was to determine the effect of a face shield (or helmet) and other factors related to pterygium in such drivers. The study was conducted in two stages, with the first stage being cross-sectional and the second a case–control study with age group matching. The participants consisted of 131 drivers, and data collection was done using a self-administered questionnaire, an observation-based checklist, and an eye examination. The results showed that the prevalence of pterygium was 19.1%. Factors affecting the incidence of pterygium in the drivers were level of education (p = 0.029, OR = 3.310), history of antioxidant consumption (p = 0.018, OR = 5.087), knowledge regarding face shield wearing (p < 0.001, OR = 10.286), and face shield wearing behavior (p < 0.001, OR = 11.156). The results indicate that occurrence of pterygium in motorcycle taxi drivers can be reduced because of proper wearing of a face shield (or helmet).

Changing trends in pterygium management

Pterygia are progressive unilateral or bilateral ocular surface growths that develop within palpebral aperture area that leads to contour disruption with symptoms ranging from foreign body sensation to cosmetic blemish. Commonly, they appear during the active period of human life, generally between third and fourth decade. Fate of pterygium spans from progressive growth in its earlier stages that undergo diversity of changes such as inflammation, infection, and degeneration ultimately ending in regressive stage during the sixth to eighth decade of life. Pterygium recurrence is the main complication encountered by surgically treating it with or without adjuvant. Not uncommonly pterygium occurrence had been described during childhood that resolved by conservative treatment. Untreated pterygia might grow exuberantly with the invasion of corneal layers, which might result in significant visual loss due to visual axis obstruction and high astigmatism. Therefore, it is justifiable to treat pterygia at any clinical stage of presentation to prevent ocular morbidity and recurrences. Common misbelief in letting the pterygia until corneal encroachment develops should be made understandable to public by conducting awareness programs. Primary objectives of the present review article are to search for the most successful method in terms of nil to low recurrence rates by various modality of treatment and to arrive at promising surgical technique that provided maximum relief in terms of survival rates on the basis of follow-up duration. Secondary objectives are related to intra- and post-operative complications, which have an effect on the ocular surface and final visual gain or loss.

Prevalence and Risk Factors of Pterygium Occurrence in Population above 50 Years Old in Bali

Background: Pterygium is a common ocular disease with etiology that has not yet well understood. Study on adult populations show the prevalence of pterygium tend to begin at fifth decade of age. The aim of this study is to determine the prevalence of pterygium and its relation to age, gender, educational level, occupation, hours spent outdoors per day, use of protective equipments, hypertension, and smoking as risk factors of pterygium among population age 50 years and above in Bali. Method: An analytic cross sectional study was conducted among population age 50 years and above in Bali between November to December 2015. The data were collected by interview using questionnaire and examinations. There were 720 subjects involved in this study. Chi square and multivariate analysis using Poisson regression were used for detecting association between risk factors with pterygium. Results: Pterygium was found in 36.4% subjects. Multivariate analysis showed pterygium was significantly related with educational level and occupation (APR 0.858; 95% CI 0.741-0.995 and APR 1.755; 95% CI 1.302-2.366, respectively). Conclusion: Prevalence of pterygium in population aged above 50 years in Bali was 36.4%. Pterygium was significantly associated with educational level and occupation in population aged above 50 years in Bali.

Outcome of different techniques of pterygium excision with conjunctival autografting in pediatric population: Our experience in central India.

Aim:To analyze surgical outcome of pterygium excision with conjunctival autografting in pediatric population ≤16 years.Settings and Design:Retrospective case series.Materials and Methods:A case sheet review of 145 patients (167 eyes) aged ≤16 years consecutively presented with pterygium from April 2008 to August 2014 in the single center was done. Twenty-six eyes of 25 children who underwent pterygium excision with conjunctival autograft were analyzed. Different techniques used to secure conjunctival autograft in a position were multiple interrupted 8-0 vicryl sutures, single 8-0 vicryl suture in the center of graft and sutureless glue free. Outcome measures were a failure of surgery and recurrence.Results:Of the total 167 eyes, 26 eyes of 25 children, mean age 13.07 ± 3.08 years (range 7–16 years) were managed surgically with pterygium excision and conjunctival autograft. The rest of the patients were managed conservatively. In 18 eyes, the graft was secured with multiple sutures, in 6 eyes with a single suture, whereas in 2 eyes, sutureless glue-free graft opposition was done. Mean follow-up was 8.03 months. No case of graft retraction, graft dehiscence or graft displacement was found. Recurrence occurred in 6 eyes and managed surgically.Conclusions:Occurrence of pterygium is not uncommon in the pediatric population. A single suture or sutureless glue-free technique may be good alternative for securing conjunctival autograft after pterygium excision in children.

The role of heredity in pterygium development.

Several risk factors, which include heredity, ultra-violet (UV) light and chronic inflammation, contribute to pterygium development. However, there is no report integrating these factors in the pathogenesis of pterygium. The aim of this review is to describe the connection between heredity, UV, and inflammation in pterygium development. Existing reports indicate that sunlight exposure is the main factor in pterygium occurrence by inducing growth factor production or chronic inflammation or DNA damage. Heredity may be a factor. Our studies on factors in pterygium occurrence and recurrence identify that heredity is crucial for pterygium to develop, and that sunlight is only a trigger, and that chronic inflammation promotes pterygium enlargement. We propose that genetic factors may interfere with the control of fibrovascular proliferation while UV light or (sunlight) most likely only triggers pterygium development by inducing growth factors which promote vibrant fibrovascular proliferation in predisposed individuals. It also just triggers inflammation and collagenolysis, which may be promoters of the enlargement of the fibrovascular mass. Pterygium probably occurs in the presence of exuberant collagen production and profuse neovascularisation.

Prevalence and pattern of eye disorders among commercial motorcycle riders in Ile-Ife, Osun State

To describe the prevalence and pattern of eye disorders existing among commercial motorcycle riders (CMRs) in Ile-Ife, Osun State. Materials, Subjects and Methods: A total of 1626 registered CMRs operated in 40 registered motorcycle assembly units in Ile-Ife. Using a multi- staged random sampling technique, a total of 322 riders were randomly selected from 10 units. Equal number of 322 was selected from the sample space as control. Structured questionnaires were administered and ocular examination carried out. SA total of 312 (96.9%) CMRs had normal vision (better than 6/18) in the better eye. The observed prevalence of subnormal visual acuity (<6/18-3/60) was 3.1% (10 CMRs) while prevalence of monocular vision was 2.8% (9 riders). Cataract and glaucoma were the major causes of visual impairment and blindness. The common ocular conditions seen were presbyopia (11.8%), allergic conjunctivitis (11.5%), glaucoma suspect (8.1%), pterygium (4.7%), pingueculum (4.0%), uncorrected refractive error (3.7%) and cataract (2.8%). It was also observed that the longer the years of riding experience of these riders, the higher the occurrence of pterygium with a significant statistical impact of p value of 0.009. Presbyopia was also the commonest disorder amongst the control group (11.2%). Presbyopia was the most common finding from the study while the commonest anterior segment disorder was pterygium which was an occupation- related ocular disorder. Causes of blindness seen were avoidable.

Chronic inflammatory cells and damaged limbal cells in pterygium

Chronic inflammation in pterygium occurrence has not been explained. Whether damaged limbal basal epithelial cells are associated with pterygium occurrence in black Africans is not clear. To explain chronic inflammation in pterygium, and to clarify whether damaged limbal basal epithelial cells were associated with pterygium occurrence in black Africans. Chronic inflammatory changes and damaged limbal basal epithelial cells were assessed in 59 samples. Chronic inflammatory cells were present in 59 pterygia. Inflammatory cell count in 5 (27.8%) of 18 small pterygia was >200 (high) while in 22 (53.7%) of 41 large growths was <200 (low); p = 0.25. The proportion of pterygia with high counts tended to increase with pterygium extent. Twenty (33.9%) of 59 pterygia recurred after surgery. Ten (50%) of 20 samples had high cell counts and 10 (50%), low counts; p = 0.40. P53 expression was detected in 11 (18.6%) of 59 pterygium samples and 5 (71.4%) of 7 controls; p = 0.007. MMP 1 staining was present in 14 (23.7%) of 59 sections and 5 (71.4%) of 7 controls; p = 0.02. MMP2 in 16 (27.1%) cases and 5 (71.4%) controls; p = 0.03. MMP3 was overexpressed in 16 (27.1%) of 59 cases and 5 (71.4%) controls; p = 0.03. Mild chronic inflammation has a tendency to be more frequent than severe inflammation in pterygia. It is clear that damaged limbal basal epithelial cells are unlikely to be related to pterygium occurrence.

Traditional eye medication and pterygium occurrence in Limpopo Province

The relative importance of environmental and hereditary factors in the occurrence of pterygium in African blacks has not been reported. To investigate the relative significance of factors associated with pterygium occurrence. This was a prospective case-controlled study where 150 pterygium patients and 150 controls participated. Interviews were conducted, eyes examined and multivariate analysis done. The families of 51 pterygium cases and 50 controls were examined for presence of pterygium. Of 150 cases and 150 controls, 79 (52.6%) and 60 (40%) used traditional eye drops (odds ratio (OR) 2.03; p=0.009. Ten cases (6.6%) and 26 controls (17.3%) had unstable tear film (OR 0.30; p=0.007. Forty-six cases (30.6%) and 15 controls (10%) reported a positive family history (OR 3.93; p<0.001). Groups of 3 - 5 pterygium cases in a household occurred in 36 of 51 pterygium families (70.5%) v. 1 of 50 controls (2%). Pterygium occurrence was associated with the use of traditional eye drops, a positive family history and having groups of diagnosed pterygium-affected relatives. However, unstable tear film seemed protective against pterygium occurrence.

Relationships of heredity and dry eye with pterygia in black African patients

Little is known about hereditary influence in pterygium occurrence in black Africans. We prospectively interviewed 71 cases and 71 controls on family history. Tear film stability was assessed. 36% of the cases and 10% of the controls had positive history (OR 4.5, p<0.05 chi square test). 7% of the cases and 17% of the controls had poor tear film (OR 0.24, p<0.05 chi square test). A positive family history was associated with pterygium occurrence. Dry eye was not associated with pterygia.

Associations between Arsenic in Drinking Water and Pterygium in Southwestern Taiwan

BackgroundPterygium is a fibrovascular growth of the bulbar conjunctiva and underlying subconjunctival tissue that may cause blindness. The mechanism of pterygium formation is not yet fully understood, but pterygium has some tumorlike features.ObjectivesThe objective of this study was to evaluate the association between arsenic exposure through drinking water and the occurrence of pterygium in southwestern Taiwan.MethodsWe recruited participants > 40 years of age from three villages in the arseniasis-endemic area in southwestern Taiwan (exposure villages) and four neighboring nonendemic villages (comparison villages). Each participant received an eye examination and a questionnaire interview. Photographs taken of both eyes were later graded by an ophthalmologist to determine pterygium status.ResultsWe included 223 participants from the exposure villages and 160 from the comparison villages. The prevalence of pterygium was higher in the exposure villages across all age groups in both sexes and increased with cumulative arsenic exposure. We found a significant association between cumulative arsenic exposure and the prevalence of pterygium. After adjusting for age, sex, working under sunlight, and working in sandy environments, we found that cumulative arsenic exposure of 0.1–15.0 mg/L-year and ≥ 15.1 mg/L-year were associated with increased risks of developing pterygium. The adjusted odds ratios were 2.04 [95% confidence interval (CI), 1.04–3.99] and 2.88 (95% CI, 1.42–5.83), respectively.ConclusionsChronic exposure to arsenic in drinking water was related to the occurrence of pterygium, and the association was still observed after adjusting for exposures to sunlight and sandy environments.

Thio-Tepa Therapy to Prevent Postoperative Pterygium Occurrence and Neovascularization

Thio-Tepa Therapy to Prevent Postoperative Pterygium Occurrence and Neovascularization

Some Statistical Observations on the Frequency of Occurrence of Pterygium and Pinguecula in Relation to Age

Some Statistical Observations on the Frequency of Occurrence of Pterygium and Pinguecula in Relation to Age