Treatment Of Pterygium Research Articles

The presence of T-lymphocyte subpopulations (CD4 and CD8) in pterygia: Evaluation of the inflammatory response

The aim of our study was to confirm the presence of inflammatory T-lymphocyte subpopulations (CD4 and CD8) in pterygium specimens with regards to clinical severity. Additionally, we examined the effect of topical anti-inflammatory agents on the presence of T-lymphocyte subpopulations. Pterygia from nineteen eyes of nineteen patients who underwent surgical excision at Duke University, North Carolina, were included in this study. Normal conjunctiva from one patient was included as a control. Pterygia were pre-operatively graded as mild, moderate or severe based on objective signs of inflammation. Immunohistochemical staining for both CD4 and CD8 subpopulations of T lymphocytes was performed. Distribution of lymphocytes within the epithelium and substantia propria was graded by a masked observer on the following scale: 0 (none/rare), 1+ (mild), 2+ (moderate), or 3+ severe. Statistical analysis was performed using the Fisher exact test and Chi-square test. A total of 16 (84%) pterygia specimens stained for T lymphocytes displayed approximately equal CD4 and CD8 infiltration of both the epithelium and the substantia propria. The majority of CD4 and CD8 lymphocytes were located in aggregates in the epithelium and upper substantia propria. The control specimen contained scant evidence of lymphocytic infiltration. There was no significant difference in the amount of lymphocytic infiltration between mild, moderate or severe pterygia. There was also no significant difference in lymphocytic infiltration between patients with (n=8) or without (n=11) a history of topical anti-inflammatory use. The presence of CD4 and CD8 lymphocytes was confirmed in pterygia. There was no significant difference in lymphocytic infiltrate in patients with or without prior topical anti-inflammatory use. Based on these findings, topical immunomodulators may have an adjunctive role in the treatment of pterygia.

Treatment of pterygium with mitomycin C and triamcinolone combined stem cell transplantation

目的 探讨丝裂霉素C(MMC)、氟羟强的松龙联合干细胞移植治疗翼状胬肉的临床疗效.方法 我们通过对145例(160眼)翼状胬肉手术中一次性应用MMC氟羟强的松龙,术后进行6个月-2年随访观察.结果 对本组145例(160眼)随访观察,治愈135眼(84.3%),有效20眼(12.5%),无效5眼(3.12%).结论 MMC、氟羟强的松龙联合干细胞移植治疗翼状胬肉疗效好,并发症少。

Clinical obervation of biotic amniotic membrane for treatment of pterygium

目的 探讨生物羊膜治疗翼状胬肉的临床效果和手术方法.方法 采用生物羊膜覆盖术治疗25例(25眼)翼状胬肉.结果 25眼行此手术,术后观察羊膜片在2～3周后溶解,随访6～15月,2眼复发,复发率为8.0%.结论 生物羊膜可有效防止翼状胬肉的复发。

Clinical efficacy of amniotic membrane transplantation in the treatment of various ocular surface diseases

Purpose To investigate the efficacy of permanent amniotic membrane transplantation (AMT) for the treatment of various ocular surface diseases. Methods The medical records of 62 eyes from 58 patients who had undergone permanent AMT were reviewed. The amniotic patches were grafted for the treatment of neurotrophic ulcers ( n = 15), inflammatory corneal ulcers ( n = 15), scleral ulcers ( n = 11), painful bullous keratopathy ( n = 8) and pterygium as an adjuvant to a conjunctival autograft ( n = 13). Cryo-preserved or freeze-dried amniotic membrane (AM) were used. The overall success rate, the interval to epithelialization, pain-subsiding time, and complications were evaluated. The pain relief and the full epithelialization interval in the bullous keratopathy patients given the cryo-preserved AM were compared with those given the freeze-dried AM. Results The success rate in the patients with neurotrophic ulcer, inflammatory corneal ulcer, scleral ulcer and bullous keratopathy were 93.3%, 66.7%, 92.9% and 100%, respectively. A conjunctival autograft with AMT showed a 100% success rate without recurrence. The time to re-epithelialization was 24.4 ± 24.2, 20.4 ± 5.8, and 16.9 ± 7.0 days in patients with neurotrophic, inflammatory and scleral ulcers, respectively ( p = 0.431). The pain relief interval in the cryo-preserved and freeze-dried AM group was 17.7 and 23.3 days, and the re-epithelialization interval was 29 and 22 days, respectively, which was insignificant. Conclusions AMT has a high success in the treatment of neurotrophic, scleral ulcer, bullous keratopathy and pterygium with a low rate of complications but presented only partial success in the treatment of inflammatory corneal ulcers. The clinical efficacy of AMT was not related to the methods used to preserve the AM.

Clinical Results After Application of Bevacizumab in Recurrent Pterygium

Purpose: To clinically establish the effectiveness and safety of bevacizumab on recurrent pterygium. Methods: Twenty patients with recurrent pterygium were given a subconjunctival injection of 0.3 cc bevacizumab, and were evaluated for periodic clinical results at 1 week, 2 weeks, 4 weeks, and every month thereafter. The patients were also evaluated for clinical results and complications. Results: Of recurrent pterygium patients with bevacizumab injection, the conjunctival injection decreased maximally after 1 to 2 weeks, but significantly increased at 4 weeks (above the lowest level measured at 1 to 2 weeks), and no patient presented conjunctival injection above the pre-injection level at 3 months, except in 2 cases. Two weeks after the injection, ICG anterior segment angiography revealed a significant decrease (30.14+17.69%) in vessel thickness of the pterygium 2 weeks after the bevacizumab injection compared to before the injection. There had been no cases of progression of pterygium, and no ocular or systemic complications due to bevacizumab. Conclusions: As shown above in the results, subconjunctival injection of 0.3 cc bevacizumab decreased the conjunctival injection and effectively suppressed any further progression of pterygium. Thus, bevacizumab subconjunctival injection appears to be effective in recurrent pterygium treatment instead of surgical methods.

Transplantation of limbal autograft and bulbal conjunctive for patients with pterygium

目的 探讨治疗巨大翼状胬肉及复发性翼状胬肉的有效方法.方法 对27例(27眼)巨大翼状胬肉及复发性翼状胬肉行胬肉切除加自体球结膜移植或自体角膜缘移植联合球结膜移植术.Ⅰ组8例(自体球结膜移植组)翼状胬肉单纯切除后取同眼颞上方球结膜移植于巩膜暴露区,Ⅱ组19例(自体角膜缘移植联合球结膜移植组)翼状胬肉单纯切除后取同眼颞上方结膜角膜缘上皮组织移植于巩膜暴露区.所有病例均在手术显微镜下操作.结果 术后平均随访9.4月,自体球结膜移植组复发Ⅰ例,自体角膜缘移植联合球结膜移植组未见复发.结论 自体角膜缘移植联合球结膜移植治疗翼状胬肉疗效良好。

Pay attention to basic and clinical research of pterygium

Pterygium is one of the most common ocular surface diseases. The pathogenesis of pterygium is unclear, and a guideline for drug therapy and surgical treatment has not been established up to now. Ultraviolet light is the most important etiologic factor of pterygium. Destruction of the limbal epithelium barrier is the most important mechanism of pterygium. The most important histopathogenesis of pterygium is degeneration and proliferation of conjunctiva. This article attempts to sketch the mechanism of pterygium and propose several questions for further investigation, and recommends excision of pterygium combined with conjunctival autograft or amniotic membrane graft or limbal conjunctival autograft as the primary surgical procedure. The study of the pathogenesis and clinical guideline for the diagnosis and treatment of pterygium should be emphasized in order to reduce the occurrence and recurrence of pterygium.

Study on microsurgical procedures for pterygium operation and its therapeutic effects

To study the microsurgical procedures for the treatment of large primary pterygium and their therapeutic effects. To observe the recurrence rate, the changes of visual acuity after microsurgery and the pathological relationships between pterygium and cornea/sclera under the surgical microscope. Forty-six eyes of forty-one patients with pterygium which invading the cornea over the pupil border were included. Pterygium was dissected by various methods under surgical microscope. The pathological relationship between the pterygium and cornea/sclera was observed. The lengths of the pterygium head and its three parts were measured. Degenerative Tenon's capsule was removed totally and the wound was covered by rotated conjunctival flaps. These patients were followed-up for 12.0 - 50.2 months (median: 22.4 months). Changes in visual acuity and recurrence rate after operation were observed. The average length of the total pterygium heads was (6.3 +/- 0.4) mm. The head was divided into three parts: the apical, loose and adhesive parts. The apical part was located at the top of the pterygium head with a length of (1.7 +/- 0.4) mm. The tissue of apical part was compact, hard, translucent and adhered to the cornea tissue. The adhesive part was a band in front of the anterior border of the limbus and paralleled to the limbus. The width of adhesive part was (0.9 +/- 0.1) mm and was tightly adhered to the cornea. The loose part lied between the apical and the adhesive part. The length of which was (3.6 +/- 0.4) mm and could be separated from the cornea easily. The neck and the body parts of pterygium could be separated easily from the limbus and sclera. Non-corrected visual acuity averaged 0.3 (ranged from finger count to 0.7) before the operation and averaged 0.7 (ranged from finger count to 1.5) 1 month postoperatively (Wilcoxon signed rank test u = 5.435, P < 0.01). Pterygium relapsed in 5 eyes with a recurrence rate of 11% (5/46). There is a regular pathological relationship between the pterygium and the cornea/sclera under surgical microscope, which is fundamental for the microsurgery of the pterygium. Extensively degenerated Tenon's capsule should be removed totally and the defect should be covered by rotated conjunctival flaps. The recurrence rate is low and the visual acuity increases significantly after the operation.

Treatment of recurrent pterygium treated by microsurgical management

目的 用显微外科技术治疗复发性翼状胬肉,同时比较角膜缘干细胞移植联合丝裂霉素C(mitomycin C,MMC)治疗复发性翼状胬肉的临床疗效.方法 将62例(67眼)患者随机分为2组,治疗组采用角膜缘干细胞移植联合应用丝裂霉素C,共34例(38眼);对照组单纯采用角膜缘干细胞移植技术,共28例(29眼),术后随访6～30 个月.结果 治疗组1眼复发,复发率2.63%,对照组3眼复发,复发率10.34%,两组比较差异有统计学意义(P＜0.05),角膜创面上皮平均愈合时间治疗组为(6.61±1.79)d,对照组为(5.83±1.91)d,两组比较差异无统计学意义(P＞0.05).结论 角膜缘干细胞移植术联合应用丝裂霉素C治疗复发性翼状胬肉再复发率低,未发生不良并发症,为治疗复发性翼状胬状安全和有效的手术方法。

Amniotic membrane transplantation or combined with limbal autograft transplantation for the treatment of pterygium

目的 观察单纯羊膜移植与联合自体角膜缘移植治疗翼状胬肉的疗效.方法 将翼状胬肉85例(93眼)随机分成两组,A组44例(45眼)行羊膜移植术,B组41例(48眼)行自体角膜缘移植联合羊膜移植术.术后平均随访2年,比较两组的治愈情况及复发率.结果 A组有4眼复发,其中有3眼是复发性翼状胬肉,复发率8.89%(4/45).B组仅1眼复发,复发率为2.08%(1/48).两组复发率差异有统计学意义(P＜0.05).结论 自体角膜缘移植联合羊膜移植术有利于翼状胬肉术后的眼表重建,临床疗效优于单纯羊膜移植术。

Comparison of limbal-conjunctival autograft and intraoperative 0.02% mitomycin-C for treatment of primary pterygium

To compare the outcomes of use of intraoperative 0.02% mitomycin-C (MMC) and limbal-conjunctival autograft (LCAG) for treatment of primary pterygia. One hundred and twelve eyes of eighty patients with primary pterygia were randomly treated either by intraoperative 0.02% MMC for 5 min or LCAG. Recurrence (defined as fibrovascular tissue invading the cornea >1.5 mm) and complications were evaluated. Fifty-two eyes were included in the MMC group and sixty in the LCAG group. Recurrence occurred in three eyes (5.76%) in the MMC group and in two eyes (3.33%) in the LCAG group. This difference between recurrence in the two groups was not statistically significant (P > 0.05). Incidence of complications such as conjunctival cysts, symblephara, conjunctival hyperemia, and subconjunctival hemorrhage was similar in both groups (P > 0.05) whereas corneal epithelial defects (CED), irritation, lacrimation, and photophobia were more common in the MMC group (P < 0.05). Simple excision then intraoperative use of 0.02% (MMC) for 5 min or LCAG are similarly successful in the treatment of primary pterygia. Some complications, for example irritation, lacrimation, photophobia, and CED are more common when simple excision is followed by MMC.

Current concepts and techniques in pterygium treatment

Pterygium is a common ocular disorder in many parts of the world. At present, there is a wide variety of surgical methods but very few clinical guidelines on the optimal treatment of primary or recurrent pterygium. The purpose of this review is to summarize the more recent and relevant studies on pterygium treatment. The primary aim is to excise the pterygium and prevent its recurrence. As bare sclera excision is associated with a high recurrence rate, pterygium excision is often combined with conjunctival autograft, mitomycin C, beta-irradiation or other adjunctive therapies to reduce recurrence rates. There is currently, however, no consensus regarding the ideal treatment for the disease. Comparability between studies is also hampered by the various definitions of pterygium recurrence. This article reviews the current concepts and techniques used for the treatment of pterygium. Conjunctival autografting and mitomycin C application are the most commonly used methods for preventing recurrences. The use of mitomycin C and beta-irradiation should be used judiciously because of the potential long-term risk of sight-threatening complications. Additional clinical trials should be performed to evaluate the relative efficacies and long-term safety of the various treatment modalities.

Mitomycin C and conjunctival autograft for recurrent pterygium

To observe the efficiency of intraoperative low-dose Mitomycin-C combined with conjunctival autograft in the treatment of recurrent pterygium. Fifteen eyes with recurrent pterygium were included in this study. The mean age of the patients was 51.6 +/- 11.4 (9 men, 6 women). All patients underwent excision of the pterygium tissue and subconjunctival fibrous tissue with a no cautery approach. 0.2 mg/ml Mitomycin-C (0.02%) was applied for 3 min. Conjunctival autograft was obtained from the superotemporal bulbar conjunctiva of the same eye. Eyes were followed for a mean period of 21.0 +/- 9.1 months. Recurrence was seen in two eyes (13.3%) during the follow-up period. The only complication seen was graft edema (two eyes; 13.3%) which healed after pressure patching. Graft necrosis, scleral melting or failure of revascularization was not noted. Intraoperative application of 0.2 mg/ml Mitomycin-C combined with conjunctival autograft reduces recurrence in recurrent pterygium cases, with minimal complications.

Simple excision alone versus simple excision plus mitomycin C in the treatment of pterygium

BACKGROUNDPterygium is a common ocular disorder throughout the world. The purpose of this study was to evaluate the efficacy of simple excision alone with or without topical mitomycin in the treatment of pterygium.PATIENTS AND METHODSThis study was performed in two stages. In the first stage, from 1991 to 1994, 100 patients (group 1) were operated on with simple excision and in the second stage, from 1995 to 1999, 300 patients (group 2) were treated with the same procedure plus topical mitomycin (0.02% eye drops four times a day for 4 days after operation). All cases were followed for 5 years. The recurrence rate of pterygium in these two treated groups were compared.RESULTSThe mean age of the subjects was 49±13 years in group 1 and 47±17 years in group 2. The clinical manifestations in these two groups were similar (P>0.05). After one year, relapse was seen in 21 cases (21%) in group 1 and in 3 cases (1%) in group 2. After five years, 31 cases (31%) in group 1 and 3 cases (1%) in group 2 had relapse (P=0.0001). The mean time to recurrence at five years for the simple excision group was 3.83 years (95% CI: 3.48 to 4.17 years) and for simple excision plus mitomycin C was 4.96 years (95% CI: 4.91 to 5.0 years) (P<0.0001).CONCLUSIONInstillation of mitomycin C eye drops appears to be safe in the treatment of pterygium.

Exposição de fibroblastos provenientes de pterígios recidivados e da cápsula de Tenon normal ao tacrolimus (FK-506)

To evaluate fibroblast proliferation activity of normal Tenon's capsule and of recurrent pterygia exposed in vitro to tacrolimus (FK506). A randomized prospective study was performed with 8 samples of recurrent pterygia and 6 samples of normal Tenon's capsule from the same patient with pterygium at the Faculdade de Medicina de Botucatu - UNESP. The samples were cultivated and exposed once to 1M tacrolimus (FK 506) and the proliferation rate was evaluated 1, 5, 12 and 19 days after the exposure. The data were statistically analyzed. The fibroblasts from pterygia exposed in vitro to tacrolimus had a significantly lower proliferation rate than controls after one day of exposure (p<0.05). Nineteen days after exposure to tacrolimus, exposed cells proliferated more than the non-exposed. Tacrolimus is effective to inhibit proliferation of Tenon's capsule fibroblasts from pterygia one day after exposure. Further studies are needed to define the role of tacrolimus in pterygium treatment.

Comparison of Three Methods for the Treatment of Pterygium: Amniotic Membrane Graft, Conjunctival Autograft and Conjunctival Autograft plus Mitomycin C.

Objective: To compare three techniques combined with excision in the treatment of primary and recurrent pterygium: amniotic membrane transplantation, conjunctival autograft, and conjunctival autograft plus mitomycin C. Materials and Methods: Forty-nine eyes of 49 subjects (30 primary, 19 recurrent pterygium) were included in this study. Combined with excision, 25 eyes (18 primary, 7 recurrent pterygium) were treated with conjunctival autografts (Group 1), and 16 eyes (12 primary, 4 recurrent pterygium) were treated with amniotic membrane transplantation for the closure of the defect (Group 2). In 8 eyes (all recurrent pterygium) low-dose mitomycin C (0.02%) was applied topically to the defect area and a conjunctival autograft was applied thereafter (Group 3). The three groups were compared with regard to the recurrence of pterygium and the defect area requiring treatment. Results: The number and percentages of recurrence seen in groups 1, 2 and 3 were as follows: 4 (16%), 4 (25%), and 0(−), respectively. For the treatment of primary pterygium cases, amniotic membrane closure and conjunctival autograft closure were comparable in effectiveness (p > 0.05). In the treatment of recurrent pterygium, there was no significant difference between the three techniques (p > 0.05). Amniotic membrane closure and conjunctival autografts were equally effective for the treatment of both primary and recurrent pterygium (p > 0.05). The graft size was significantly larger in the cases with recurrent pterygium (p = 0.016). Conclusions: Amniotic membrane closure and conjunctival autografts seem to be equally effective in the prevention of recurrence of primary pterygium. Conjunctival autografts combined with mitomycin C are as effective as the above two techniques to prevent recurrence in the treatment of recurrent pterygium. Due to the larger area of subconjunctival fibrosis, a larger defect area is created after the excision of pterygium tissue and a larger graft is needed to close this defect in recurrent pterygium. This factor can guide the surgeon during the planning of the surgery to choose the most appropriate technique for closure of the defect.

Intraoperative Ethanol Treatment as an Adjuvant Therapy of Pterygium Excision

Recurrence of pterygium is the main concern for ophthalmic surgeons after the excision of pterygium. To evaluate the efficacy and safety of ethanol treatment during pterygium excision in preventing the recurrence of pterygia, a prospective randomized study was performed of 78 eyes in primary pterygium patients treated by excision. Primary pterygium patients were randomly assigned to ethanol group (38 eyes given intraoperative ethanol) or mitomycin-c (MMC) group (40 eyes given intraoperative MMC). Ethanol (20%) was applied for 60 seconds to the pterygial and its adjacent corneal surfaces before pterygium excision. After excision, the excised site of sclera was soaked with 20% Ethanol for 60 seconds. In group 2, MMC (0.25 mg/ml) was applied for 60 seconds to the bare sclera after pterygium excision. The outcomes were followed for more than one year. Pterygium recurred in 2 (5.3%) of 38 eyes in ethanol group and 4(10.0%) of 40 eyes in MMC group. Final appearance of the pterygium excision area was satisfactory in 73.6% of group1 and 67.5% of group 4. No patients experienced severe complications postoperatively. In comparison with MMC treatment, intraoperative ethanol is more efficacious in preventing recurrence of pterygium and causes fewer complications. It suggests this regimen as an alternative for the treatment of pterygium, especially for those patients of high risk group for MMC treatment complications.

Transplantation of conjunctival limbal autograft and amniotic membrane vs mitomycin C and amniotic membrane in treatment of recurrent pterygium

To compare the efficacy and complications of conjunctival limbal autograft (CLAU) and amniotic membrane transplantation (AMT) vsintraoperative mitomycin C (MMC) and AMT for treatment of recurrent pterygium. Forty eyes of 40 patients with recurrent pterygium underwent CLAU and AMT (20 eyes) or intraoperative MMC (0.02%, 3 min) and AMT (20 eyes). Three eyes (15%) had symblepharon before surgery in each group. Recurrence was compared in each group by using chi(2) test. No major postoperative complications occurred during 6-19 months of follow-up. In CLAU/AMT group, no pterygium recurrence was observed. Recurrence occurred in four eyes (20%) in MMC/AMT group after 3 and 4 months (P-value=0.035, chi(2) test). No recurrence of pterygium or symblepharon was seen in six eyes with recurrent pterygium and symblepharon (three eyes in each group). CLAU with AMT seems to be more effective than intraoperative MMC with AMT for treatment of recurrent pterygium.

Exposição de fibroblastos da cápsula de Tenon de pterígios à ciclosporina 0,05%

To evaluate normal Tenon capsule fibroblasts and from pterygia in culture when exposed to cyclosporin 0.05%. A prospective, randomized study was done, involving 20 patients with primary pterygium. Samples of normal and pterygium Tenon's capsule from the same individual were collected, cultured and exposed to cyclosporin 0.05%. Only 7 samples could be exposed to cyclosporin--6 from pterygial Tenon's capsule and 1 from normal Tenon's capsule. There was a significant reduction of cellular proliferation in the cyclosporin exposed cultures (p<0.05). Cyclosporin 0.05% is effective to inhibit the proliferation of pterygia and normal Tenon's capsule fibroblasts. Further studies should be performed to define the role of cyclosporin in pterygium treatment.

Narrow-Strip Conjunctival Autograft for Treatment of Pterygium

To determine the efficacy of narrow-strip conjunctival autograft surgery in the treatment of pterygium. Retrospective noncomparative interventional case series. Twenty-one consecutive interventions between 1994 and 2005 in 20 eyes of 18 patients for primary (n = 17 cases) or recurrent (n = 4 cases) pterygia. Surgical excision of the pterygium and conjunctival transplantation with a narrow-strip technique. In all cases, a 2-mm-wide autograft was secured adjacent and posterior to the limbus, leaving a 2- to 3-mm zone of bare sclera between the graft and the anterior margin of the conjunctival wound. All conjunctival margins were secured by suture to bare sclera. Recurrence of pterygium at 12 months. Mean follow-up after surgery was 41 months (median, 42; range, 4-132). At 1 year and all time points thereafter, 18 of 19 (94.7%) cases were free of recurrence. One patient was lost to follow-up at 4 months, and another died after 9 months of follow-up. The lone recurrence occurred inferiorly in an eye that had undergone an adjacent narrow-strip conjunctival transplantation 6 months previously for a recurrent temporal pterygium. The same patient remains recurrence-free 67 months after inferior pterygium excision and a second narrow-strip autograft surgery. Narrow-strip conjunctival autografting appears to be an effective surgical technique in preventing pterygium recurrence. Creating an intervening bare sclera area between the secured conjunctival graft and the anterior margin of the conjunctival wound may be important in preventing recurrence.