Pterygium Research Articles

Clinical analysis of modified pterygium excision with limbal-conjunctival flap grafting

Objective To investigate the operation method and clinical effect of modified pterygium excision with limbal-conjunctival flap grafting.Methods Excision of pterygium and limbal conjunctival autografting were performed on 92 eyes of 77 cases.6 to 12 months postoperative fllow-up,to observe the operation effect.Results 87 eyes (94.57％) were cured and 5 eyes recurred.The recurrence rate was 5.43％.Conclusion Modified pterygium excision with limbal-conjunctival flap grafting is an better method for the treatment of pterygium.Intraoperative standard operation is one of the key measures to ensure the low recurrence rate after operation. Key words: Pterygium ; Cells, stem ; Grafting ; Limbus, cornea

Comparison on clinical efficacy of limbal autograft transplantation and amniotic membrane transplantation in treating pterygium

Objective To explore the clinical effects of limbal autograft transplantation (LAT) and amniotic membrane transplantation (AMT) in treating ptery gium.Methods 180 eyes of 159 cases with pterygium were randomly divided into two groups:LAT group (90 eyes in 81 cases) and AMT group (90 eyes in 78 cases).The recurrences of pterygium were observed and analyzed during the follow-up of 12 months.Results The corneal healing time of LAT group was (5.50 ± 1.27) days,while (8.70 ± 1.49) days in AMT group,it was statistically significant (P ＜ 0.01).There were 3 recurrences (3.33％) in LAT group and 16 recurrences (17.78％) in AMT group and it was statistically significant (P ＜ 0.01).Conclusion LAT could improve the corneal healing time and decrease the recurrence rate,which may be a valuable and effective way in clinic to treat pterygium. Key words: Pterygium; Limbal autograft transplantation; Amniotic membrane transplantation; Efficacy observation

The clinical study of conjunctival graft thickness measurement with anterior optical coherence tomography after pterygium surgery

Objective To observe the change of conjunctival graft thickness with application of anterior segment optical coherence tomography (AS-OCT) in short-term after pterygium excision.Methods A retrospective analysis of pterygium surgery in 13 eyes of 13 patients.The conjunctival graft thickness 1 mm,2 mm and 3 mm posterior to the scleral spur was measured with Visante OCT at 1 week,1 month and 3 month after surgery.The normal temporal bulbar conjuctival thickness was also measured at the same location.Results The thickness of conjunctival graft reached to maximum was (456 ± 169) μm in 1 week postoperation,it gradually decreased to (303 ± 64)μm in 1 month,the difference between 1 week and 1 month values was statistically significant (t =3.055,P =0.002).The average graft thickness was (289 ± 117) μm 3 months postoperatively.Compared with 1 month postoperatively,there was no statistically significant difference between the two time points (t =0.695,P =0.89).The normal temporal bulbar conjunctival thickness was (58 ± 16)μm,(61 ± 14)μm and (61 ± 19)μm at 1 week,1 month and 3 month respective,with no statistically significant difference.At the same time point,the graft thickness was greater than normal conjunctival thickness.Conclusion At 1 week after pterygium surgery,the conjunctival graft thickness was significant thickening measured by AS-OCT.From 1 month to 3 month,the thickness value had a trend of thinning gradually.AS-OCT can made accurate evaluation in conjunctival graft thickness after pterygium surgery. Key words: Optical coherence tomography, anterior segment; Pterygium Graft, conjunctival; Thickness, conjunctival

A study on changes in keratometry readings and astigmatism induced by pterygium before and after pterygium excision surgery

Background: Pterygium is a wing shaped fibrovascular growth of subconjunctival tissue encroaching upon the cornea from the either side within the interpalpebral fissure area inducing significant astigmatism. Surgical intervention for excision of pterygium leads to reduction in astigmatism which significantly improves vision. Aim: To study changes in corneal astigmatism before and after pterygium excision surgery. Material and Methods: The study was carried out on 100 eyes of 95 patients who had primary pterygium and were admitted in Department of Ophthalmology, P. D. U. Govt. Medical College, Rajkot and underwent pterygium surgery during period of October 2012 to April 2013. All patients underwent preoperative assessment for visual acuity, anterior segment examination, posterior segment examination, auto refraction and auto keratometry. After pterygium surgery, patients were assessed for visual acuity, auto refraction and auto keratometry on 1st, 7th and 45th post operative day and the results were analysed. Results: Mean astigmatism preoperatively was found to be 6.20 ± 3.58 Diopters (D) which subsequently decreased to 1.20 ± 1.27 D on 45th post operative day-showing 5.09 ± 3.32 D of change in astigmatism which was statistically significant(paired t-test, p<0.05). Conclusion: Pterygium causes significant corneal astigmatism, which hampers vision of the patient. Excision of pterygium leads to statistically significant reduction in astigmatism, which improves vision significantly. Keywords: Pterygium, astigmatism, keratometry, pterygium excision, vision.

Combined conjunctival autograft and overlay amniotic membrane transplantation; a novel surgical treatment for pterygium.

The authors report the long-term results of combined conjunctival autograft and overlay amniotic membrane transplantation (AMT) for treatment of pterygium as a new surgical technique. Nineteen patients including 12 male and 7 female subjects with pterygium (primary, 14 cases; recurrent, 5 cases) underwent combined conjunctival autograft and overlay AMT and were followed from 10 to 26 months. Mean age was 44.21±12.49 (range, 29.0-73.0) years. In one patient with grade T3 primary pterygium, the lesion recurred (5.2%, recurrence rate). No intra-and postoperative complication developed. This procedure seems a safe and effective surgical technique for pterygium treatment. Protection of the ocular surface during the early postoperative period reduces the friction-induced inflammation and might be helpful to prevent the recurrence.

Mitomycin C related complications shouldn't be neglected in the pterygium surgery

Mitomycin C (MMC), as it could reduce tissue adhesions and scar formation, has been widely adopted in pterygium surgery to lower the recurrence rate.Upon a certain therapeutic effect obtained, a variety of ocular complications was combined and always occupies a quite long time after MMC application.once occurred, it was tough to cure. Compared to autologous limbal-conjunctival grafts, MMC has no apparent advantage to reduce reoccurrence of pterygium. Therefore, it is advised to abandon the use of MMC in pterygium surgery.

The inhibitory effect of mycophenolic acid on pterygium fibroblast

Background Studies showed that macophenolic acid (MPA)down-regulates and inhibits the expression and secretion of tissue growth factor and inflammatory factor,and further impacts the proliferation and inflammation process.Pterygium is an inflammatory and proliferative lesion.Whether MPA has an inhibitory effect on pterygium is unclear.Objective This study was to investigate the antifibrotic effects of macophenolic acid on pterygium fibroblasts(PFBs) in vitro and discuss its mechanism.Methods Pterygium tissue was obtained from pterygium patient during the surgery.PFBs were cultured using explants and identified with vimentin immunohistochemisty.0,0.125,0.250,0.500,1.000 μmol/L MPA were added into the culture medium,respectively,and the cells were cultured in the medium without MPA as the control group.MTT colorimetry was used to find the optimization effective concentration of MPA and evaluate their inhibitory effect on PFBs,and BrdU fluorescence staining was used to assess the growth statue of PFBs.Expressions of nuclear factor-κB(NF-κB),p65 and inhibitor of NF-κB-α(IκB-α) in the cells were detected by Western blot.Results The cells was spindle in shape 3 days after cultured and showed the vortex and radial arrangement with the positive response to vimentin.With the increase of MPA,the proliferative value of PFBs (A560)showed gradually decline,with a significant difference among the five groups (F =42.874,P＜0.01).In addition,the proliferative value of PFBs (A560) significantly lowed as the prolong of MPA active time(F=26.038,P＜0.01).BrdU fluorescence staining showed a significant decrease of DNA synthesis of PFBs with the elevation of MPA dose among the five groups(F=175.279,P＜0.05),and the A560of PFBs DNA synthesis in different concentrations of MPA groups was lower than that of the control group (all at P＜0.05).No apoptotic and necrotic cell was found after MPA action by DAPI staining.The expression level of p65 in the PFBs was 0.886±0.072 and 1.542±0.124 in the MPA group and the control group,indicating a declined value in the MPA group(P＜0.05).However,the expression value of IκB-α in the cytoplasm PFBs was significantly higher in the MPA group compared with the control group(2.141 ±0.305 vs.1.559±0.267) (P＜0.05).Conclusions MPA has an inhibitory effect on the growth of PFBs,which probably is related to the arresting of NF-κB pathway. Key words: Pterygium; Fibroblast; Proliferation; Macophenolic acid; p65; Nuclear factor-κB

The Epidemiology, Possible Risk Factors and Clinical Presentation of Pterygium at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria

development of pterygium. This is a hospital based retrospective review of patients diagnosed to have pterygium at the Olabisi Onabanjo University Teaching Hospital in Sagamu, Ogun State, Nigeria between January 2006 and December 2009. Data was obtained from the case files of patients. The age, sex, place of abode, occupation, level of education, pattern of presentation and type of treatment offered were recorded and analyzed. Two hundred and thirty-three patients were diagnosed to have pterygium within the 3 years study period but only 178 case notes were retrieved. Age range was between 8 years and 85years with a mean of 50.9years ±15.6 standard deviation. Pterygium was most common in the age group 41-60years. There was a male: female ratio of 1:1.8. Ninety-four (52.8%) of the patients were traders, 10 were students, 8 were teachers while 4 were farmers. Sixty (33.7%) patients presented because there was growth in their eyes while 44 complained of redness. One hundred and twenty-nine (72.5%) patients had bilateral pterygia while 49 (27.5%) were unilateral cases. One hundred and eight (60.7%) had bilateral nasal lesion and same number (129) of patients came with a presenting visual acuity of 6/18 and better. Seventy-eight patients (43.8%) were treated conservatively with eye drops while 39 (21.9%) had excision with adjuvant 5 fluorouracil [FU]. Bilaterality and preponderance of female gender are important findings in this study. The perceived presence of pterygium was a predominant reason for seeking eye care. Keywords: Epidemiology, Risk factors, Clinical presentation, pterygium, Nigeria Nigerian Medical Practitioner Vol. 63 No 1-2, 2013

A brief history of diagnosis and treatment of Pterygium in China and outside China

Pterygium, an old and commonly occurred eye disease, featuring obvious proliferation of triangular tissues grown in the bulbar conjunctiva which may also invade the cornea. Despite uncertainty about optimal treatment for pterygium, significant progress in pathological theory that a pterygium comprises a potentially highly proliferative tissue and the shortage of stem cells in the corneal margin has been made in the past year in understanding the pathogenesis of this enigmatic disease. These advances have influenced the surgical and medical approach to the management of this common and often recurrent disease.

Phototherapeutic keratectomy for treatment of recurrent pterygium

Objective To evaluate the treatment outcomes of excimer laser phototherapeutic keratectomy (PTK) for recurrent pterygium.Methods 106 eyes of 106 patients diagnosed with recurrent pterygium that underwent PTK or autologous limbal stem cell transplantation were retrospectively evaluated.PTK treatment group (53 eyes):Pterygia were treated by separating and excising conjunctiva and pathological tissues.The residual pathological tissues underwent PTK with the Technolas 217z excimer laser.Control group (53 eyes):autologous limbal stem cell transplantation was performed.Data were analyzed for preoperative and postoperative reepitheliation,recurrence rate,and corneal astigmatism.Results The mean reepitheliation time of PTK group was (3.96 ± 0.78) days,and it was significantly shorter than that of control group (4.67 ± 1.01) days (t =-4.071,P ＜ 0.01).The mean postoperative corneal astigmatism in PTK group declined about (0.72 ± 0.80) D comparing to the preoperative one,and the improvement was signifi-cantly more than that of the control group (0.42 ± 0.43 D) (t =-1.342,P =0.02).The mean follow-up time was (18.05 ± 5.32) months.3 cases recurred in PTK group,the recurrence rate was 5.66％ ; 4 cases recurred in control group,the recurrence rate was 7.55％.There was no significant difference in recurrent rate between the two groups (x2 =0.368,P =0.70).Conclusion PTK can be a safe and effective therapeutic alternative for recurrent pterygium.It can avoid excessive operative trauma,hasten reepitheliation,and reduce corneal astigmastism.It can effectively decrease the recurrence rate of pterygium as autologous limbal stem cell transplantation. Key words: Keratectomy, phototherapeutic ; Pterygium; Stem cell, limbal

Application of fetal limbal stem cell in the treatment of pseudopterygium

Objective To study the clinical effect of fetal limbal stem cell in the treatment of pseudopterygium.Methods 16 eyes of 16 patients had been peformed the operation of pseudopterygium excision combined with fetal limbal stem cell transplantation.Fresh human fetal limbal stem cell with donors' gestational age of 28 weeks or more were used intraoperatively.The medicine preventing immune rejection were used after operation.Corneo-conjunctival healing,immune rejection,palindromia of pterygium and intraocular pressure were observed in the follow-up.Results The patients were followed up for (9.4 ± 2.4)months.The average time for the corneal epithelial healing was (3.8 ± 1.3) d.In the follow-up,13 cases (81.3 ％) of corneal epithelial continued complete,1 case (6.3 ％) recurred pseudoperygium.The number of epithelial rejection were 7 cases,3 cases,0 case and 0 case at 1 m,3 ms,6 ms and at the last follow-up time after operation,but the rejection was controlled through medication,the average time of medicine treatment was (3.9 ± 1.3) d.At 1,3,and 6 months after surgery and the last follow-up,the mean rating value of graft rejection were 0.6 ± 0.9,1.0 ± 1.1,0.3 ± 0.8,0.3 ± 0.8.Six months after operation,there were 3 cases of graft dissolution.Two cases were significantly improved by anti-rejection medication,another one had continued dissolution and the graft failed to survive.Conclusion Preliminary results are satisfactory for the treatment of pseudopterygium caused by physic and chemical damage through transplanting fetal limbal stem cell,it provides a new idea for the clinical treatment of those diseases. Key words: Fetal; Stem cell, limbal; Tissue transplantation; Pseudopterygium

Analysis of the effect of pterygium treated by different clinical methods

Objective To compare the clinical efficacy of pterygium treated by grafting auto conjunctiva and amniotic membrane transplantation.Methods 82 patients with primary pterygium were selected,and the number of affected eyes was 97.The eyes were randomly divided into A group and B group.Grafting auto conjunctiva was used in A group after pterygium cut,while amniotic membrane transplantation used in B group.The situation of conjunctiva and cornea and the proliferation of artery and pterygium were observed.Results The mean time of epithelial healing time in A group (5.21 ± 1.08) d was significantly shorter than that (7.16 ± 1.57) d in B group (t =5.973,P ＜0.05).The relapse rate in A group was 2.04％,which was lower than 16.67％ in B group (x2 =29.364,P ＜ 0.05).Conclusion The relapse rate after pterygium cut in surgery could be reduced by grafting auto conjunctiva with cornea,and the speed of corneal wound repair could be accelerated.The effect was good,and it was worthy of clinical application. Key words: Pterygium; Ophthalmologic surgical procedures; Transplantation

Cosmetic effect of two kinds of conjunctival transplantation for pterygium

Objective To study the best cosmetic effect of pterygium excision combined with conjunctival transplantation.Methods The total of 102 patients (110 eyes) with primary pterygium had beenrandomly allocated into two groups:group A and group B,who had all received pterygium excision and transfer operation for pedical conjunctival transposition were in group A,who had all received pterygium retrograde removed joint limbal stem cells free conjunctival transplantation in group B.All the patients of the two groups had been followed up for 24 months,to compare the surgical recurrence rate and cosmetic effect.Results The recurrence rate in two group had no significant difference(P ＞ 0.05),the cosmetic effect in two group had significant difference by statistical comparative analysis(P ＜ 0.05).Conclusion Pterygium retrograde removed joint limbal stem cells free conjunctival transplantation is more effective than pterygium excision and transfer operation for pedical conjunctival transposition in comsmetic effect. Key words: Pterygium ; Conjunctival transplantation; Recurrence rate ; Cosmetic effect

Prevalence of pterygium in seawater saltern and clinical observation on operation treatment of pterygium

Objective This study aims to determine the prevalence of pterygium among workers aged 45 years and older in a seawater saltern in Jiangsu Province and identify the relationship among age,gender,environment,and pterygium.This study also observes the therapeutic effects of limbal stem cell autograft transplantation.Methods With the use of cluster random sampling method,we selected 12,062 workers (24124 eyes),and the incidence,and prevalence of pterygium in the area were analyzed.Among 83 eyes of 76 cases with pterygium were operated on using limbal stem cell autograft transplantation.The operated patients were followed up for 10 months to 24 months.Results A total of 618 (5.645％) workers had pterygium.No statistical significant difference was found between men (as a rate of 5.484％) and women (as a rate of 5.787％) with pterygium (P ＞ 0.05).The prevalence of pterygium increased along with age (P ＜ 0.05).It was higher in people aged 55 years to 64 years than that in people aged 45 eyes to 54 eyes.There was no difference between people aged 55 years to 64 years and people aged older than 65 years (P ＞ 0.05).Three of the 83 eyes operated had occurred recurrent pterygium after operation,with a recurrene rate of 3.614％.Conclusion The prevalence of pterygium correlates to geographic setting,sun light and ultraviolet exposure,age,economic status.The key point of pterygium treatment focuses on the functional reconstructed of the corneal limbus.Limbal stem cell autograft transplantation is the ideal treatment method for pterygium. Key words: Pterygium; Prevalence ; Seawater saltern; Limbal stem cell

Comparison of clinical efficacy between two different surgical treatments of pterygium

Objective To evaluate the clinical efficacy of two different surgery of primary pterygium.Methods A total of 81 eyes of 65 patients with pterygiums were divided into two groups.All the cases used reverse method to dilacerate pterygium firstly.Mitomyicin C in Group A,while corneal limbal stem cell autograft in Group B.the following up ranged from 12 to 24 months.Results Peteygium recurrence in 7 eyes (18.92％) in Group A (37 eyes),in 1 eyes(2.27％) in group B(44 eyes).Data was analyzed using Chi-Square testing,there were statistically significant differences between the two groups (P ＜ 0.05).Conclusion Comparison of two different surgical treatments of pterygium with reverse method.Corneal limbal stem cell autograft can more effectively lower recurrence rate. Key words: Pterygium; Surgery; Mitomycin C; Autograft; Cell, stem, limbal, corneal

The effect of Naphazoline & trace dexamethasone in the perioperative period of pterygium surgery

Objective To explore the effect of Naphazoline & trace dexamethasone in the perioperative period of pterygium surgery.Methods 106 cases of pterygium (121 eyes) were divided into 2 groups (treatment group and control group).Naphazoline & trace dexamethasone were applied in the treatment group (62 eyes).Tobramycin were applied in the control group (59 eyes).Corneal epithelial healing time,conjunctival hyperemia subsided time and the recurrence rate of pterygium after operation at different time points were selected as the main outcomes.Results There was no statistical significance between the treatment group (3.67 ± 1.31d) and the control group (3.25 ± 1.04d) on the corneal epithelium healing time (t =1.947,P ＞ 0.05).Compared with the control group (21.40 ± 6.78d),conjunctival hyperemia subsided time was shorter in the treatment group (15.50 ± 4.45d),which has statistical significance (t =5.6,P＜0.01).The rate of recurrence in the treatment group was much lower than that in the control group.The difference reached statistical significance (x2 =3.856,P ＜ 0.05).Conclusion Naphazoline & trace dexamethasone in the perioperative period of pterygium surgery can effectively control the inflammatory response and reduce the recurrence with high safety. Key words: Naphazoline ; Dexamethasone ; Pterygium ; Period, perioperative

Evaluation of biological amniotic membrane transplantation for recurrent pterygium

Objective To evaluate the efficacy and safety of biological amniotic membrane transplantation for recurrent pterygium.Methods 12 cases(12 eyes) with recurrent pterygium were treated by pterygium resection + amniotic membrane transplantation.The post operative follow-up period was 1 year.Results 4 cases(4eyes) were recurrent.The recurrent rate was 33.3％.Visual acuity all improved postoperatively with no symblepharon or infection.Conclusion Amniotic membrane transplantation is a safe and effective method for recurrent pterygium surgery. Key words: Biological amniotic membrane; Pterygium, recurrent ; Surgical operation

Modified excision of pterygium combined with autogenous free bulbar conjunctival transplantation

Objective To investigate the therapeutic effect of using the method of improved pterygium excision,combined with autogenous free bulbar conjunctiva transplantation for the treatment of primary pterygium.Methods Limbus conjunctiva incision,tunnel-like separation of pterygium body,Subepithelial split of pterygium head,autogenous conjunctival transplantation to scleral defect.78 cases (90 eye) of primary pterygium surgery,were followed up in postoperative 6 ～ 12 months,averaging (9.85 ± 2.36) months.Results All reactions in patients were mild,without any special discomfort except slight pain and foreign body sensation 1 ～ 2 days after operation.Corneal epithelium was basically recovered in postoperative 3 ～ 4days,with negative fluorescent staining.Of the 78 cases (90 eyes),5 cases suffered from open of conjunctival wound upon demolition of suture due to early excessive eye movement,without shift and off,2 cases suffered from glaucoma,1 cases suffered from granulation hyperplasia on conjunctival wound on postoperative 15 days,1 case was found subconjunctival liquid uplift,local Lymphoma liquid retention 1 month after operation,4 eyes suffered from recurrence (recurrence rate 4.44％),without any other complications.Conclusion The improved excision of pterygium,achieves effect of small wound,slight reaction and faster healing.The excision of pterygium was complete and safety,combined with autogenous free bulbar conjunctival transplantation,with lower recurrence rate and worthing promoting. Key words: Excision of pterygium,modified ; Transplantation,conjunctival,bulbar

The transplantion of amniotic membrane grafting and mitomycin C in treatment of recurrent pterygium

Objective To study the transplantion of amniotic membrane grafting and mitomycin C (MMC) in treatment of recurrent pterygium.Methods 42 cases(45 eyes) of recurrent pterygium were envolved.All of them had accepted pterygium excision and amniotic membrane grafting.The MMC was not applicated in group A(21 cases,22 eyes).Only 21 cases(23 eyes) in group B had undergone a piece of cotton contained 0.2 mg/mL MMC being put on the exposed sclera for 5 min in the surgery.Results The followup was 12 months,4 eyes (18.18％) in group A and 1 eye (4.3％) in group B recurred.There were obvious difference between the two groups (P ＜ 0.05).Conclusion Transplantation of amniotic membrane grafting and mitomycin C can prevent postoperative recurrence of pterygium.It is effective and simple for recurrent ptrergium. Key words: Pterygium; Amniotic membrane grafting; Mitomycin C

The effect of sutureless autologous corneal stem cell transplantation in pterygium surgery

Objective To study the safety and efficacy of the sutureless autologous corneal stem cell transplantation for pterygium.Methods 43 cases of pterygium underwent excision combined with corneal stem cells transplantation.The graft was connected with the bed by thermal coagulation with ophthalmic electrocautery.The healing,recurrance and complaints were observed.Results The graft connected with the bed well except graft displacement occurred in one eye.The corneal cells healed entirely at 3 days postoperatively.Irrigating symptoms occurred in 4 eyes.Pterygium recurred in 3 eyes at 1 year postoperatively with 6.98％ recurrence rate.Conclusion Sutureless corneal autologous stem cells transplantation is safe and effective for pterygium which shorten operation duration and avoid suturing and sutures removal. Key words: Pterygium; Surgery; Transplantation,stem cell,autologous; Sutureless