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Sabater-Cruz N, Figueras-Roca M, Martinez-Conesa EM, Vilarrodona A, Casaroli-Marano RP. Pterygium surgery with lyophilized versus cryopreserved amniotic membrane graft. J Fr Ophtalmol 2023; 46:258-265. [PMID: 36792470 DOI: 10.1016/j.jfo.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/03/2022] [Accepted: 08/26/2022] [Indexed: 02/17/2023]
Abstract
PURPOSE To evaluate surgical outcomes (recurrence rate, aesthetics and symptoms) of pterygium surgery with two different amniotic membrane preservation approaches - lyophilized (LAM) and cryopreserved (CAM). METHODS Primary pterygium patients were randomized to either LAM or CAM surgery. Demographic data, ocular surface disease index (OSDI), aesthetic grading (1 to 4), recurrences and complications were recorded over a 6-month follow-up period. RESULTS Twenty-nine patients were recruited. Recurrence at month 6 was detected in 11 cases (37.9%) and was more prevalent with CAM grafts, without reaching statistical significance (P=0.196). Aesthetic outcome grading showed no differences between LAM and CAM at month 6 (P=0.124). Aesthetic results were mostly unsatisfactory (grade 3 and 4) without statistical differences between groups (P=0.514). Baseline OSDI was similar in both groups (P=0.888), and it significantly decreased by the last follow-up visit (P<0.001) for both the LAM and CAM groups. This decrease did not significantly differ between amniotic membrane preservation approach surgery groups (P=0.714). CONCLUSION LAM might be considered a legitimate alternative to CAM, showing no inferiority in outcomes, since clinical and aesthetic outcomes were similar for both groups.
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Affiliation(s)
- N Sabater-Cruz
- Hospital Clinic de Barcelona, Barcelona, Spain; Hospital Universitari Sagrat Cor, Barcelona, Spain; Barcelona Tissue Bank (BST-BTB), Barcelona, Spain; Admiravision, Barcelona, Spain.
| | | | - E M Martinez-Conesa
- Barcelona Tissue Bank (BST-BTB), Barcelona, Spain; Institute of Biomedical Research (IIB-Sant Pau, SGR1113), Barcelona, Spain
| | - A Vilarrodona
- Barcelona Tissue Bank (BST-BTB), Barcelona, Spain; Institute of Biomedical Research (IIB-Sant Pau, SGR1113), Barcelona, Spain
| | - R P Casaroli-Marano
- Hospital Clinic de Barcelona, Barcelona, Spain; Barcelona Tissue Bank (BST-BTB), Barcelona, Spain; Institute of Biomedical Research (IIB-Sant Pau, SGR1113), Barcelona, Spain; Department of Surgery, School of Medicine, University of Barcelona, Barcelona, Spain
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2
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Ji Y, Liu S, Hong X, Lu Y, Wu X, Li K, Li K, Liu Y. Advances in artificial intelligence applications for ocular surface diseases diagnosis. Front Cell Dev Biol 2022; 10:1107689. [PMID: 36605721 PMCID: PMC9808405 DOI: 10.3389/fcell.2022.1107689] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
In recent years, with the rapid development of computer technology, continual optimization of various learning algorithms and architectures, and establishment of numerous large databases, artificial intelligence (AI) has been unprecedentedly developed and applied in the field of ophthalmology. In the past, ophthalmological AI research mainly focused on posterior segment diseases, such as diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, retinal vein occlusion, and glaucoma optic neuropathy. Meanwhile, an increasing number of studies have employed AI to diagnose ocular surface diseases. In this review, we summarize the research progress of AI in the diagnosis of several ocular surface diseases, namely keratitis, keratoconus, dry eye, and pterygium. We discuss the limitations and challenges of AI in the diagnosis of ocular surface diseases, as well as prospects for the future.
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Affiliation(s)
- Yuke Ji
- The Laboratory of Artificial Intelligence and Bigdata in Ophthalmology, Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Sha Liu
- The Laboratory of Artificial Intelligence and Bigdata in Ophthalmology, Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangqian Hong
- Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Yi Lu
- Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Xingyang Wu
- Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Kunke Li
- Shenzhen Eye Hospital, Jinan University, Shenzhen, China,*Correspondence: Yunfang Liu, ; Keran Li, ; Kunke Li,
| | - Keran Li
- The Laboratory of Artificial Intelligence and Bigdata in Ophthalmology, Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Yunfang Liu, ; Keran Li, ; Kunke Li,
| | - Yunfang Liu
- Department of Ophthalmology, First Affiliated Hospital of Huzhou University, Huzhou, China,*Correspondence: Yunfang Liu, ; Keran Li, ; Kunke Li,
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Computer-Assisted Pterygium Screening System: A Review. Diagnostics (Basel) 2022; 12:diagnostics12030639. [PMID: 35328192 PMCID: PMC8947201 DOI: 10.3390/diagnostics12030639] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 12/10/2022] Open
Abstract
Pterygium is an eye condition that causes the fibrovascular tissues to grow towards the corneal region. At the early stage, it is not a harmful condition, except for slight discomfort for the patients. However, it will start to affect the eyesight of the patient once the tissues encroach towards the corneal region, with a more serious impact if it has grown into the pupil region. Therefore, this condition needs to be identified as early as possible to halt its growth, with the use of simple eye drops and sunglasses. One of the associated risk factors for this condition is a low educational level, which explains the reason that the majority of the patients are not aware of this condition. Hence, it is important to develop an automated pterygium screening system based on simple imaging modalities such as a mobile phone camera so that it can be assessed by many people. During the early stage of automated pterygium screening system development, conventional machine learning techniques such as support vector machines and artificial neural networks are the de facto algorithms to detect the presence of pterygium tissues. However, with the arrival of the deep learning era, coupled with the availability of large training data, deep learning networks have replaced the conventional networks in screening for the pterygium condition. The deep learning networks have been successfully implemented for three major purposes, which are to classify an image regarding whether there is the presence of pterygium tissues or not, to localize the lesion tissues through object detection methodology, and to semantically segment the lesion tissues at the pixel level. This review paper summarizes the type, severity, risk factors, and existing state-of-the-art technology in automated pterygium screening systems. A few available datasets are also discussed in this paper for both classification and segmentation tasks. In conclusion, a computer-assisted pterygium screening system will benefit many people all over the world, especially in alerting them to the possibility of having this condition so that preventive actions can be advised at an early stage.
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4
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Guo Z, Wang Y, Wang L, Li Q, Yuan X, Hua X. NLRP3 and NLRP6 expression in pterygium and normal conjunctiva and their relationship with pterygium formation and recurrence. Eur J Ophthalmol 2022; 32:3058-3063. [PMID: 35068231 DOI: 10.1177/11206721221074200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose This study aimed to explore the pterygium formation and recurrence, by detecting the expression of Nod-like receptor pyrin domain 3 (NLRP3) and Nod-like receptor pyrin domain 6 (NLRP6) in pterygium and evaluate the correlation between NLRP3 and NLRP6 in pterygium. Methods In this prospective study, the expression levels of NLRP3 and NLRP6, with their related effectors, were evaluated in primary pterygium (n = 40) and recurrent pterygium (n = 32) tissue samples and compared with normal conjunctiva (n = 11) tissue samples by immunohistochemistry. Results Compared to the normal conjunctiva group, the expression levels of NLRP3, caspase-1, IL-18, and IL-1β, were significantly higher, and NLRP6 showed an expression that was significantly lower in pterygium tissue samples (P < 0.05, respectively). Compared to the primary pterygium group, the expression levels of NLRP3, caspase-1, IL-18 and IL-1β were significantly higher, and NLRP6 showed an expression that was significantly lower in recurrent pterygium tissue samples (P < 0.05, respectively).There was a negative correlation between NLRP3 expression and NLRP6 expression in normal conjunctival (r = −0.739, P = 0.009) and pterygium (r = −0.533, P = 0.000). Conclusions NLRP3 and NLRP6 may be involved in the formation and recurrence of pterygium. NLRP6 may play an anti-inflammatory role in normal conjunctival tissue to maintain conjunctival homeostasis.
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Affiliation(s)
- Zhenfeng Guo
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Tianjin Beichen Hospital, Tianjin, China
| | - Yuchuan Wang
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
| | - Lina Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Tianjin Xiaozhan Hospital, Tianjin, China
| | - Qingyu Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
| | - Xiaoyong Yuan
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
| | - Xia Hua
- Tianjin Aier Eye Hospital, Tianjin, China
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5
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Sabater-Cruz N, Martinez-Conesa E, Vilarrodona A, Casaroli-Marano RP. Lyophilized amniotic membrane graft for primary pterygium surgery: preliminary results. Cell Tissue Bank 2021; 23:401-406. [PMID: 34628551 DOI: 10.1007/s10561-021-09955-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the tolerability, safety and efficacy of new lyophilized amniotic membrane (LAM) presentation for ocular use. A prospective case-series cohort of four patients with primary nasal pterygium which undergone excision and LAM implantation was evaluated for complications and clinical outcomes. Surgical manipulation of LAM was also assessed. LAM was stiff and easy to manipulate as well as no tearing occurred during surgery or suturing. Ocular comfort was checked and similar among those patients with LAM glued or sutured. After 12 months, there were no issues about tolerability or adverse events. Lower cosmetic outcomes (recurrence) were stated in 3 patients. Our study showed that LAM could be an effective alternative to cryopreserved amniotic membrane for graft after pterygium excision surgery. Its main advantage, storage at room temperature, can make it of immediate availability. Further studies comparing clinical outcomes of pterygium surgery with cryopreserved amniotic membrane versus LAM would confirm the benefits of the last.
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Affiliation(s)
- Noelia Sabater-Cruz
- Hospital Clinic de Barcelona, C/ Sabino de Arana S/N, 08028, Barcelona, Spain. .,Hospital Universitari Sagrat Cor, Barcelona, Spain.
| | - Eva Martinez-Conesa
- Barcelona Tissue Bank (BST-BTB), Barcelona, Spain.,Institute of Biomedical Research (IIB-Sant Pau, SGR1113), Barcelona, Spain
| | - Anna Vilarrodona
- Barcelona Tissue Bank (BST-BTB), Barcelona, Spain.,Institute of Biomedical Research (IIB-Sant Pau, SGR1113), Barcelona, Spain
| | - Ricardo P Casaroli-Marano
- Hospital Clinic de Barcelona, C/ Sabino de Arana S/N, 08028, Barcelona, Spain.,Barcelona Tissue Bank (BST-BTB), Barcelona, Spain.,Department of Surgery, School of Medicine, University of Barcelona, Barcelona, Spain.,Institute of Biomedical Research (IIB-Sant Pau, SGR1113), Barcelona, Spain
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6
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Doğan E, Çakır B, Aksoy N, Köse E, Alagöz G. Does pterygium morphology affect corneal astigmatism? Ther Adv Ophthalmol 2021; 13:25158414211030423. [PMID: 34291187 PMCID: PMC8278454 DOI: 10.1177/25158414211030423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate the correlation between corneal astigmatism and the morphology of pterygium with anterior segment optic coherence tomography (AS-OCT). Material and Methods: The size of pterygium (horizontal length, vertical width) was measured manually; pterygium area and percentage extension of the pterygium onto the cornea were calculated. Anterior and posterior corneal astigmatism, Sim K, K1, K2 were measured using a dual Scheimpflug analyzer. Morphological patterns of the pterygium analyzed with AS-OCT were determined according to the extension of the pterygium apex below the corneal epithelium. Two tomographic patterns were identified: continuous and nodular. Correlation between anterior corneal astigmatism and pterygium size, percentage extension of the pterygium, and morphological pattern of the pterygium was analyzed. Results: The mean ages of the 47 patients were 49.4 ± 16.6 (22–80) years. Mean horizontal pterygium length, vertical width, pterygium area, and percentage extension of the pterygium were 2.8 ± 1.2 mm, 4.8 ± 1.6 mm, 7.42 ± 5.6 mm2 and 24.5 ± 10.4%, respectively. Mean anterior corneal astigmatism was 2.3 ± 2.3 D and simulated keratometry was 43.4 ± 2.02 D. In terms of the morphological pattern of the pterygium, 24 eyes had continuous, 23 eyes had a nodular pattern and the median (interquartile range) anterior corneal astigmatism was 1.87 (1.01–3.80) and 1.22 D (0.58–2.35), respectively (p = 0.102). Other topographic and pterygium size parameters were similar between groups. Analyzing the correlations in groups separately, a positive moderate statistically significant correlation was present between vertical width, percentage extension, pterygium area, and anterior corneal astigmatism in both continuous and nodular groups. Conclusions: Although not statistically significant, anterior corneal astigmatism was higher in continuous group. Using AS-OCT to standardize the morphology of pterygium could provide additional clinical information.
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Affiliation(s)
- Emine Doğan
- Department of Ophthalmology, Sakarya University Medical Education and Research Hospital, 54000 Sakarya, Turkey
| | - Burçin Çakır
- Department of Ophthalmology, Sakarya University Medical Education and Research Hospital, Sakarya, Turkey
| | - Nilgün Aksoy
- Department of Ophthalmology, Sakarya University Medical Education and Research Hospital, Sakarya, Turkey
| | - Elif Köse
- Department of Public Health, Sakarya University Medical Education and Research Hospital, Sakarya, Turkey
| | - Gürsoy Alagöz
- Department of Ophthalmology, Sakarya University Medical Education and Research Hospital, Sakarya, Turkey
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7
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Shahraki T, Arabi A, Feizi S. Pterygium: an update on pathophysiology, clinical features, and management. Ther Adv Ophthalmol 2021; 13:25158414211020152. [PMID: 34104871 PMCID: PMC8170279 DOI: 10.1177/25158414211020152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/06/2021] [Indexed: 01/16/2023] Open
Abstract
Pterygium is a relatively common ocular surface disease. The clinical aspects and
the treatment options have been studied since many years ago, but many
uncertainties still exist. The core pathologic pathway and the role of heredity
in the development of pterygium are still attractive fields for the researchers.
The role of pterygium in corneal irregularities, in addition to the refractive
properties of pterygium removal, has been increasingly recognized through
numerous studies. The association between pterygium and ocular surface neoplasia
is challenging the traditional beliefs regarding the safe profile of the
disease. The need for a comprehensive clinical classification system has
encouraged homogenization of trials and prediction of the recurrence rate of the
pterygium following surgical removal. Evolving surgical methods have been
associated with some complications, whose diagnosis and management are necessary
for ophthalmic surgeons. According to the review, the main risk factor of
pterygium progression remains to be the ultraviolet exposure. A major part of
the clinical evaluation should consist of differentiating between typical and
atypical pterygia, where the latter may be associated with the risk of ocular
surface neoplasia. The effect of pterygium on astigmatism and the aberrations of
the cornea may evoke the need for an early removal with a purpose of reducing
secondary refractive error. Among the surgical methods, conjunctival or
conjunctival-limbal autografting seems to be the first choice for ophthalmic
surgeons because the recurrence rate following the procedure has been reported
to be lower, compared with other procedures. The use of adjuvant options is
supported in the literature, where intraoperative and postoperative mitomycin C
has been the adjuvant treatment of choice. The efficacy and safety of
anti–vascular endothelial growth factor agents and cyclosporine have been
postulated; however, their exact role in the treatment of the pterygium requires
further studies.
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Affiliation(s)
- Toktam Shahraki
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arabi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, 16666, Iran
| | - Sepehr Feizi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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8
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Lack of HPV in pterygium with no evidence of autoinoculation and the role of cytokines in pterygium with dry eye. Sci Rep 2021; 11:2842. [PMID: 33531557 PMCID: PMC7854664 DOI: 10.1038/s41598-021-82114-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/15/2021] [Indexed: 12/16/2022] Open
Abstract
This study evaluated human papillomavirus's (HPV) role in pterygium pathogenesis, its autoinoculation from genitalia to ocular surface, potential cytokines involved, and crosstalk cytokines between pterygium and dry eye (DE). This cross-sectional study enrolled 25 healthy controls (HCs) and 116 pterygium patients. Four subgroups of pterygium and DE were used in cytokine evaluations. Conjunctival and pterygium swabs and first-void urine samples (i.e., genitalia samples) were collected for HPV DNA detection using real-time polymerase chain reaction. Tear cytokines interleukin (IL)-6, IL-18, and vascular endothelial growth factor (VEGF) in tears were evaluated. No HPV DNA was detected in conjunctival or pterygium swabs. No association was found between HPV DNA in urine samples and that from conjunctival or pterygium swabs. Tear VEGF levels were significantly higher in pterygium patients than in HCs, with no markedly different levels between primary and recurrent pterygia. Tear IL-6, IL-18, and tear VEGF were significantly higher in participants with DE, regardless of pterygium status. In conclusion, HPV infection was not a pathogenic factor of pterygia. The hypothesis of HPV transmitting from the genitals to ocular surfaces was nullified. Tear VEGF was involved in both pterygia and DE, whereas tear IL-6 and IL-18 played roles only in DE.
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9
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Sabater-Cruz N, Dotti-Boada M, Rios J, Carrion MT, Chamorro L, Sánchez-Dalmau BF, Casaroli-Marano RP. Postoperative treatment compliance rate and complications with two different protocols after pterygium excision and conjunctival autografting. Eur J Ophthalmol 2020; 31:932-937. [PMID: 32338523 DOI: 10.1177/1120672120917335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate compliance rate to pterygium postoperative treatment with two different protocols. METHODS Review of clinical data of patients submitted to pterygium excision and conjunctival autografting in a single centre (and a single surgeon) in Barcelona between March 2014 and December 2017. Initial postoperative protocol (protocol 1) consisted of 4 months of topical steroids in a tapering fashion. Protocol 2 consisted of topical steroids tapered over 5 weeks. Compliance rate, complications and clinical outcomes were evaluated, and statistical comparisons were made. RESULTS 120 surgeries were performed in 99 patients. Protocol 1 was applied in 63 cases and the next 57 followed protocol 2. Compliance with protocol 1 (57.6%) was lower than with protocol 2 (84.9%) (p = 0.002). Intraoperative complications (graft tear, corneal thinning, corneal perforation and bleeding) were found in 10 cases of protocol 1 and three cases of protocol 2, p = 0.08. Postoperative complications (graft dislocation, graft haematoma, ocular hypertension and recurrence) were found in 31 cases of protocol 1 (46.2%) and eight cases of protocol 2 (14%), p = 0.001. Six weeks after surgery, ocular hypertension was detected in eight cases corresponding to protocol 1 (13.6%) and two cases of protocol 2 (3.8%), p = 0.099. Recurrence rate during first year was higher in protocol 1 (26.3%) compared to protocol 2 (7.6%), p = 0.011. No cases of visual acuity worsening or infection were registered. CONCLUSION Protocol 2 has shown to have higher compliance rate than protocol 1 and less postoperative complications, proving to be a safe and effective postoperative treatment after pterygium surgery.
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Affiliation(s)
- Noelia Sabater-Cruz
- Ophthalmology Service, Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain.,Ophthalmology Service, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Marina Dotti-Boada
- Ophthalmology Service, Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
| | - José Rios
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic, Barcelona, Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Teresa Carrion
- Ophthalmology Service, Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Lillian Chamorro
- Ophthalmology Service, Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Bernardo F Sánchez-Dalmau
- Ophthalmology Service, Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain.,Department of Surgery, School of Medicine and Health Science, University of Barcelona, Barcelona, Spain
| | - Ricardo-Pedro Casaroli-Marano
- Ophthalmology Service, Institut Clinic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain.,Department of Surgery, School of Medicine and Health Science, University of Barcelona, Barcelona, Spain
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10
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Wu SQ, Xu QB, Sheng WY, Su LY, Zhu LW. A novel role for Livin in the response to ultraviolet B radiation and pterygium development. Int J Mol Med 2020; 45:1103-1111. [PMID: 32124942 PMCID: PMC7053875 DOI: 10.3892/ijmm.2020.4481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/04/2019] [Indexed: 12/17/2022] Open
Abstract
A pterygium is an inflammatory, invasive and proliferative lesion on the ocular surface, which can decrease visual acuity, damage the ocular surface and affect the appearance of the eye. However, the underlying molecular mechanisms of the pathogenesis remain unclear. In the present study, the role of apoptosis-associated protein Livin in the occurrence and development of pterygium was investigated. Primary samples from quiescent or advanced clinical stages of pterygium and normal human conjunctival tissues were used to assess mRNA and protein expression levels of Livin using reverse transcription-quantitative PCR and immunohistochemistry, respectively. Livin was knocked down in pterygium epithelial cells (PECs) using small interfering RNA (siRNA), to investigate the role of Livin in PEC viability, migration, invasion ability and apoptosis. The cell viability, invasion ability and apoptosis of PECs following ultraviolet B (UVB) radiation alone or in combination with Livin silencing were also analyzed. Expression levels of Livin increased in the pterygium tissues compared with those in the normal conjunctiva at both the mRNA and protein levels. Livin expression levels in advanced pterygium were significantly higher compared with those in quiescent pterygium samples. Knockdown of Livin expression levels significantly reduced cell migration, invasion ability and cell viability, and induced apoptosis of PECs. Inhibition of Livin expression in PECs increased the expression levels of caspase-7, caspase-3 and E-cadherin, whereas expression levels of Snail were downregulated. Cell viability and invasion ability in PECs was enhanced following UVB radiation and Livin expression upregulated. UVB irradiation induced cell invasion ability of PECs and this was attenuated by Livin-silencing. Transfection with Livin siRNA also partially recovered the apoptosis rate of PECs, which was reduced by UVB irradiation. In conclusion, Livin was upregulated in pterygium, and UVB radiation functions in the development of pterygium by inducing Livin expression.
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Affiliation(s)
- Shuang-Qing Wu
- Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital (Hangzhou Red‑Cross Hospital), Hangzhou, Zhejiang 310003, P.R. China
| | - Qi-Bin Xu
- Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital (Hangzhou Red‑Cross Hospital), Hangzhou, Zhejiang 310003, P.R. China
| | - Wen-Yan Sheng
- Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital (Hangzhou Red‑Cross Hospital), Hangzhou, Zhejiang 310003, P.R. China
| | - Lin-Ya Su
- Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital (Hangzhou Red‑Cross Hospital), Hangzhou, Zhejiang 310003, P.R. China
| | - Li-Wei Zhu
- Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital (Hangzhou Red‑Cross Hospital), Hangzhou, Zhejiang 310003, P.R. China
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11
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Interferon Alpha-2b Eye Drops Prevent Recurrence of Pterygium After the Bare Sclera Technique: A Single-Center, Sequential, and Controlled Study. Cornea 2019; 38:1239-1244. [PMID: 31299663 PMCID: PMC6750146 DOI: 10.1097/ico.0000000000001995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To investigate the efficacy and safety of interferon (IFN) alpha-2b eye drops in preventing pterygium recurrence after the bare sclera technique.
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12
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Low-Dose Mitomycin C Decreases the Postoperative Recurrence Rate of Pterygium by Perturbing NLRP3 Inflammatory Signalling Pathway and Suppressing the Expression of Inflammatory Factors. J Ophthalmol 2019; 2019:9472782. [PMID: 31827916 PMCID: PMC6885197 DOI: 10.1155/2019/9472782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/02/2019] [Accepted: 08/07/2019] [Indexed: 01/20/2023] Open
Abstract
A pterygium is generally believed to be a chronic inflammatory lesion caused by external stimuli that develops from the conjunctiva and grows onto the cornea. Simple bare sclera excision is the most commonly used method to treat pterygium. However, the high postoperative recurrence rate of pterygium remains a persistent challenge. Mitomycin C (MMC) is an antineoplastic antibiotic that inhibits DNA, RNA, and protein synthesis. In recent years, although MMC has proven useful for the treatment of pterygium, its application has been controversial because of its clear toxicity and the possibility of ocular complications. In the current study, we prospectively recruited patients to receive or not receive a local injection of MMC (0.4 mg/ml). Follow-up was conducted with the patients to determine the postoperative recurrence rate of pterygium and/or to observe any ocular complications. The remarkable results demonstrated that MMC can decrease the postoperative recurrence rate of pterygium without leading to serious eye complications. Further results indicated that MMC can inhibit the activation of the NLRP3 inflammatory signalling pathway and thus downregulate the expression of downstream molecules, including IL-18 and IL-1β. MMC also reduced the expression of inflammatory factors TGF-β1, VEGF, and IL-6. In addition to influencing these factors, MMC suppressed neovascularization and the proliferation of corneal fibroblasts to effectively reduce the recurrence rate of pterygium. Taken together, our results provide a theoretical basis for the development of prevention and treatment strategies for pterygium and suggest that MMC is highly effective as an adjunctive treatment after excision of primary pterygia.
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Turan M, Turan G. Overexpression of fractalkine and its histopathological characteristics in primary pterygium. Graefes Arch Clin Exp Ophthalmol 2019; 257:2743-2750. [PMID: 31637486 DOI: 10.1007/s00417-019-04463-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/23/2019] [Accepted: 09/04/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE This study aimed to evaluate the differences in the expressions of fractalkine in normal bulbar conjunctiva and primary pterygium tissues. METHODS The study included 48 patients who had been operated on for primary pterygium. Histopathologically, the presence of epithelial atypia, epithelial hyperplasia, goblet cell hyperplasia, epithelial lymphocytic exocytosis, stromal inflammation, mast cell count, and stromal vascularity were evaluated in the primary pterygium tissues. An immunohistochemical fractalkine stain was applied to the primary pterygium tissue samples and normal bulbar conjunctival tissue samples. RESULTS Primary pterygium and normal bulbar conjunctival tissue samples were histopathologically analyzed. Epithelial atypia, epithelial hyperplasia, epithelial lymphocytic exocytosis, stromal inflammation, stromal vascularity, and mast cell count were found to be significantly higher in the primary pterygium (p = 0.001, p = 0.002, p = 0.024, p = 0.007, p = 0.024, and p = 0.013, respectively). When evaluated in terms of fractalkine expression, the epithelial, vascular endothelial, and inflammatory cells were significantly higher in the primary pterygium (p ≤ 0.001, p = 0.002, p = 0.001, respectively). Moreover, compared to the normal bulbar conjunctiva, Ki-67 expression was significantly higher in the primary pterygium tissue samples. CONCLUSION Fractalkine might play a key role in the etiopathogenesis of pterygium. Fractalkine may be important in developing new treatment approaches.
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Affiliation(s)
- Meydan Turan
- Department of Ophthalmology, Balikesir Ataturk City Hospital, Balikesir, Turkey.
| | - Gulay Turan
- Faculty of Medicine, Department of Pathology, Balikesir University, Balikesir, Turkey
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Mai W, Chen M, Huang M, Zhong J, Chen J, Liu X, Deng J, Yang X, Ye W, Zhang R, Zhou Q, Zhang D. Targeting platelet-derived growth factor receptor β inhibits the proliferation and motility of human pterygial fibroblasts. Expert Opin Ther Targets 2019; 23:805-817. [PMID: 31385548 DOI: 10.1080/14728222.2019.1653281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Pterygium, a common eye disease with high postoperative recurrence, lacks effective therapeutic strategies. Therefore, it's urgent to identify specific targets to develop rationally targeted molecular drugs for the pterygial therapy. Methods: The cell proliferation and motility were studied in both the primary human pterygial fibroblasts (hPFs) and an ex vivo pterygium model. hPFs transfected with the pCMV3-PDGFRB plasmid, PDGFRB siRNA and CRISPR/Cas9 system were used to determine the role of PDGFR-β in pterygial fibroblasts functions. Western blotting, immunohistochemistry and immunofluorescence were performed to evaluate the expression of the key proteins. Results: PDGFR-β expression in the pterygial stroma and primary hPFs was significantly higher than that in the conjunctiva and human conjunctival fibroblasts. PDGF-BB promoted the proliferation, migration and invasion of hPFs, which can be significantly suppressed by sunitinib via inhibition of the PDGFR-β/extracellular signal-regulated kinase (ERK) pathway. In the ex vivo model, the knockout of PDGFRB and sunitinib treatment blocked the proliferation and motility of fibroblasts in the pterygial stroma via the suppression of PDGFR-β/ERK pathway. Conclusion: This study demonstrates that PDGFR-β may be a potential therapeutic target for pterygium, and inhibition of PDGFR-β by sunitinib is a promising and effective approach for pterygium treatment.
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Affiliation(s)
- Weiqian Mai
- College of Pharmacy, Jinan University , Guangzhou , China.,Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, Jinan University , Guangzhou , China
| | - Minfeng Chen
- College of Pharmacy, Jinan University , Guangzhou , China.,Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, Jinan University , Guangzhou , China
| | - Maohua Huang
- College of Pharmacy, Jinan University , Guangzhou , China.,Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, Jinan University , Guangzhou , China
| | - Jincheng Zhong
- College of Pharmacy, Jinan University , Guangzhou , China.,Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, Jinan University , Guangzhou , China
| | - Jian Chen
- Eye Institute, Jinan University , Guangzhou , China
| | - Xiaoyong Liu
- The First Affiliated Hospital of Jinan University , Guangzhou , China
| | - Juan Deng
- The Third Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Xiaoxi Yang
- The Sixth Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Wencai Ye
- College of Pharmacy, Jinan University , Guangzhou , China.,Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, Jinan University , Guangzhou , China
| | - Rijia Zhang
- The First Affiliated Hospital of Jinan University , Guangzhou , China
| | - Qing Zhou
- The First Affiliated Hospital of Jinan University , Guangzhou , China
| | - Dongmei Zhang
- College of Pharmacy, Jinan University , Guangzhou , China.,Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, Jinan University , Guangzhou , China
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Lešin M, Paradžik M, Marin Lovrić J, Olujić I, Ljubić Ž, Vučinović A, Bućan K, Puljak L. Cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery (CAGE CUP): study protocol of a randomised controlled trial. BMJ Open 2018; 8:e020714. [PMID: 29950464 PMCID: PMC6020953 DOI: 10.1136/bmjopen-2017-020714] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pterygium is a non-cancerous growth of the conjunctival tissue over the cornea that may lead to visual impairment in advanced stages, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence of pterygium is a frequent problem. It has been previously shown that fibrin glue may result in less recurrence and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery. However, fibrin glue is a biological material and it carries the risk of transmitting infectious agents from pooled and single-donor blood donors and anaphylaxis in susceptible individuals. Cauterisation is another surgical option, and it would be advantageous to know whether cauterisation may be superior surgical option compared with fibrin glue. This protocol describes the rationale and design of the randomised controlled trial (RCT) in which we will compare cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery. METHODS AND ANALYSES This will be a parallel group RCT comparing cauterisation versus fibrin glue for conjunctival autografting in primary pterygium surgery. Computer-generated randomisation will be used, and allocation concealment will be conducted using sequentially numbered opaque sealed envelopes. Surgeons will not be blinded to the procedures, but participants, other investigators and outcome assessors will be blinded. Adult participants with primary pterygium operated in a tertiary hospital in Split, Croatia, will be included. Primary outcome will be recurrence of pterygium, defined as any regrowth of tissue from the area of excision across the limbus onto the cornea after 180 days. ETHICS AND DISSEMINATION The trial was approved by the ethics review board of the University Hospital Split (500-03/17-01/68). Results will be disseminated at conferences and through peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03321201; Pre-results.
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Affiliation(s)
- Mladen Lešin
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Martina Paradžik
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | | | - Ivana Olujić
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Žana Ljubić
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Ana Vučinović
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Kajo Bućan
- Department of Ophthalmology, University Hospital Split, Split, Croatia
| | - Livia Puljak
- Laboratory for Pain Research Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Split, Croatia
- Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia
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Extracellular matrix and fibroblast injection produces pterygium-like lesion in rabbits. Biol Res 2018; 51:15. [PMID: 29866159 PMCID: PMC5987467 DOI: 10.1186/s40659-018-0165-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/24/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Translational research to develop pharmaceutical and surgical treatments for pterygium requires a reliable and easy to produce animal model. Extracellular matrix and fibroblast are important components of pterygium. The aim of this study was to analyze the effect of the subconjunctival injection of fibroblast cells (NIH3T3 cell line) and exogenous extracellular matrix in rabbits in producing a pterygium-like lesion. METHODS Six 3-month-old white New Zealand rabbits were injected with 20,000 NIH3T3 cells and 5 µL of Matrigel in the right conjunctiva, and with only 5 µL of Matrigel in the left conjunctiva. The eyes were photographed under a magnification of 16× using a 12-megapixel digital camera attached to the microscope on day 1, 3 and 7. Conjunctival vascularization was measured by analyzing images to measure red pixel saturation. Area of corneal and conjunctival fibrovascular tissue formation on the site of injection was assessed by analyzing the images on day 3 and 7 using area measurement software. Histopathologic characteristics were determined in the rabbit tissues and compared with a human primary pterygium. RESULTS The two treatments promoted growth of conjunctival fibrovascular tissue at day 7. The red pixel saturation and area of fibrovascular tissue developed was significantly higher in right eyes (p < 0.05). Tissues from both treatments showed neovascularization in lesser extent to that observed in human pterygium. Acanthosis, stromal inflammation, and edema were found in tissues of both treatments. No elastosis was found in either treatment. CONCLUSIONS Matrigel alone or in combination with NIH3T3 cells injected into the rabbits' conjunctiva can promote tissue growth with characteristics of human pterygium, including neovascularization, acanthosis, stromal inflammation, and edema. The combination of Matrigel with NIH3T3 cells seems to have an additive effect on the size and redness of the pterygium-like tissue developed.
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Abstract
The fibrocyte, which was first described in 1994, is a type of circulating mesenchymal progenitor cell in the peripheral blood. Fibrocytes play important roles in chronic inflammation, wound healing, tissue remodeling, and fibrosis. Emerging evidence indicates that fibrocytes are involved in a wide variety of ocular disorders associated with inflammation and fibrosis. In this review, we summarize recent advances regarding the general characteristic profile of fibrocytes, molecular mechanisms underlying the fibrocyte recruitment to target tissues, their differentiation into fibroblasts, and the potential role of fibrocytes in ocular disease. Given the critical role of fibrocytes in ocular disorders, fibrocytes may serve as a promising pharmaceutical target in the development of novel therapeutic strategies to treat ocular inflammation and fibrosis.
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Affiliation(s)
- Feng Zhang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, 410011, Hunan Province, China
| | - Ke Liu
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, 410011, Hunan Province, China
| | - Han Zhao
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, 410011, Hunan Province, China
| | - Yan He
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China. .,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, 410011, Hunan Province, China.
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Reda AM, Shaaban YMM, Saad El-Din SA. Histopathological Parameters in Pterygia and Significant Clinical Correlations. J Ophthalmic Vis Res 2018; 13:110-118. [PMID: 29719637 PMCID: PMC5905302 DOI: 10.4103/jovr.jovr_31_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: To evaluate the clinical and histopathological parameters of pterygium to determine significant correlations between parameters that can affect management strategies. Methods: A total of 47 pterygia were clinically examined and excised for histopathological evaluation of epithelial and stromal changes. Some samples were immunostained with P53 (a protein of 53 kilodalton used as dysplastic epithelial marker), CD20 (CD/cluster of differentiation, are group of surface receptors providing targets for cellular immunophenotyping, CD20 as a B lymphocyte marker), CD 3 (as T lymphocyte marker) or vascular endothelial growth factor (VEGF/as vascular marker). Results: Most patients were male (59.6%). Cosmetic complaints (83%), grade II redness (61.7%), grade 2 extension (63.8), and associated astigmatism of <2.5 D (83%) were observed. Histopathological features included solar elastosis (100%), squamous hyperplasia (83%), increased stromal vascularity with hemorrhage (76.6%), and lymphocytic stromal infiltration, perivascular distribution, and mild epithelial lymphocytic exocytosis in 72.3%, 74.5%, and 70.2% of cases, respectively. Other changes included goblet cell hyperplasia (31.9%), prominent epithelial pigmentation (48.9%), and, most importantly, epithelial atypia (53.2%). Clinical redness was significantly correlated with vascularity, epithelial hyperplasia, and lymphocytic stromal infiltration; lymphocytic stromal infiltration was also significantly correlated with pterygium extension and with low astigmatism. Conclusion: The inflammatory response was mild in most cases and the density was not significantly correlated with any clinical parameter. Vascularity was related to clinical redness. Treatment with anti-VEGF may be beneficial, even for grade 1 pterygia that are not dominantly fibrotic.
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Affiliation(s)
- Ahmed Mohamed Reda
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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