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Background/aims To compare the long-term outcomes of primary pterygium surgery with combined conjunctival rotational autograft and mitomycin C (CRA-MMC), mitomycin C alone (MMC) and limbal conjunctival autograft (LCAU). Methods The outcomes of primary pterygium excision followed by conjunctival rotational autograft (CRA) combined with intraoperative 0.02% MMC for 5 min (group 1, CRA-MMC, n=61) were compared with historical control groups consisting of, pterygium excision with MMC (group 2, n=47), and, pterygium excision with limbal conjunctival autograft (LCAU) (group 3, n=29). The main outcome measures were recurrence rate and complications. Results The mean follow-up period was 101±3 months, 138±2 and 137±2 months in the CRA-MMC, MMC and LCAU groups respectively. Recurrence was noted in one patient (1.6%) in the CRA-MMC, 12 patients with MMC (25.5%) and 2 patients with LCAU (6.9%). The difference in recurrence rate between CRA-MMC and MMC was statistically significant (p<0.001). Early postoperative complications included 3 conjunctival cysts (1 from the CRA-MMC, 2 with MMC alone), 2 symblephara (1 in the MMC group, 1 in the LCAU group), and 1 granuloma in the CRA-MMC group. Conclusions Pterygium excision followed by CRA-MMC or LCAU are effective means of preventing recurrence. The use of CRA-MMC in pterygium excision may be considered for cases where conventional autograft harvesting is contraindicated or when large grafts for double-head pterygium are required. [ABSTRACT FROM AUTHOR]

Aims To assess the efficacy of securing conjunctival autograft (CAG) without glue or sutures, using the patient's own blood at the surgical site, and to compare it with the current accepted standard of using fibrin glue for graft adherence, in pterygium surgery. Methods A single-centre, prospective, randomised controlled trial was carried out in 200 eyes of patients with primary pterygia who were advised pterygium excision with CAG. Enrolled participants were assigned to Group I or II by randomisation. After excision of pterygium, they underwent CAG with autologous blood in Group I (100 eyes) and CAG with fibrin glue in Group II (100 eyes). During follow-up of 1 year, the eyes were assessed for graft adherence and recurrence. Results Of the 200 eyes randomised, 6 eyes that did not complete intended follow-up were excluded from final analysis. Of the 194 eyes (Group I n=96, Group II n=98), on the first postoperative day, 3 eyes in Group I (3.13%) had total graft dislodgement requiring regrafting from another site or reattachment with glue. In Group II also 2 eyes (2.04%) had graft dislodgement on the first postoperative day requiring regrafting from another site. During the 1-year follow-up, 6 eyes in Group I (6.25%) and 8 eyes in Group II (8.16%) developed recurrence. Conclusions Feasibilty of adherence of the graft without glue in pterygium surgery is promising and has results comparable with the fibrin glue technique in terms of long-term outcome and recurrence, suggesting the potential for autologous blood to replace fibrin glue in graft fixation. [ABSTRACT FROM AUTHOR]

Objective Pterygium is a common, benign fibrovascular disease of the human ocular surface that can impair vision and restrict ocular mobility if not removed. Surgical excision is the most common form of treatment; however, non-surgical therapeutics are being developed, which target the angiogenic component of this disease. Nestin is a class VI intermediate filament protein expressed in neuroepithelium with an emerging role in angiogenesis and tumourigenesis. Given the tumour-like and angiogenic features of pterygia, we postulated that nestin partakes in its development. Methods and Results Formalin-fixed, paraffinembedded pterygia and donor-matched conjunctiva (n=22) were obtained, sectioned and stained for nestin by immunohistochemistry and immunofluorescence. Immunoreactivity for nestin was semi-quantified and microvessel density counted. Significantly, higher nestin expression was identified in pterygium epithelial cells and blood vessels compared with matched normal conjunctiva. Interestingly, a high proportion of the pterygium specimens displayed nuclear staining for nestin within the basal and suprabasal epithelium. Immunofluorescence was used to simultaneously detect nestin in CD31+ blood vessels; however, this protein was absent from Lyve-1+ lymphatic vessels. In addition, blood and lymphatic vessel density was significantly higher in pterygia compared with corresponding control conjunctiva. Conclusions These results demonstrate for the first time the expression of nestin in the pterygium vasculature and indicate that this protein may play a central role in the angiogenic response, which characterises this disease. Targeting nestin pharmacologically could be considered as an alternative or adjuvant therapeutic strategy. [ABSTRACT FROM AUTHOR]

Background To investigate the expression levels of vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor 1 (VEGFR-1) and VEGFR-2 in pterygium and to clarify the prognostic significance of these expressions in pterygia. Methods A total of 40 surgically excised pterygia and 9 normal conjunctivae were immunohistochemically studied applying the streptavidin-biotin method in paraffin-embedded tissue sections. Monoclonal antibodies were targeted against VEGF, VEGFR-1 and VEGFR-2 proteins. At the sixth postoperative month, the recurrence rate was graded on a scale of 1-4. Results The mean percentage of VEGF-positive epithelial cells was comparable in pterygium and normal conjunctivae. However, the pterygium group presented higher expression levels of VEGF in pterygia endothelial cells (p=0.05). In terms of VEGFR-1 expression in epithelial cells, no statistically significant difference was found between two groups ( p=0.658). However, normal conjunctivae exhibited higher expression levels of VEGFR-1 in endothelial cells ( p=0.002). Epithelial cells in pterygium presented higher combined scores of VEGFR-2 (87.5% and 22.2%, respectively) ( p=0.013). While higher expression levels of VEGFR-2 were documented in pterygia endothelial cells, no VEGFR-2 immunoreactivity was observed in the endothelial cells of normal conjunctivae (p<0.001). Expression levels of VEGFR-2 in epithelial cells and endothelial cells were positively correlated with the postoperative recurrence grading system (p<0.001 and τ=0.627, p=0.001 and τ=0.508, respectively). Conclusions The results suggest that VEGF may play a key role through VEGFR-2 in the pathogenesis of pterygium. Moreover, overexpression of VEGFR-2 in pterygia may have a predictive value for a higher postoperative recurrence rate. [ABSTRACT FROM AUTHOR]

Background and aims Vascular endothelial growth factor (VEGF) gene expression has been linked to cancer progression. Here we hypothesise that the polymorphism and protein expression of VEGF are correlated with the pathogenesis and therapy response of pterygium. Methods 60 pterygial and 121 normal conjunctival samples were collected to determine the genotypes and protein expression of VEGF. Primary pterygium cells (PECs) were used to confirm the effect of the VEGF polymorphism on the angiogenesis of pterygium. Results 48 (83.3%) pterygial specimens tested positive for VEGF protein expression, which was significantly higher than in the control groups (16.7%, p<0.0001). The frequency of the 936 C>T variant, but not the -2578C>A variant, was significantly higher in the pterygium group compared with the control group. VEGF protein expression was significantly higher in the 936 C/C group than in the 936 C/T and T/T groups (p=0.001). The results of our cell model showed that PECs with the C/C genotype had a higher angiogenesis ability and higher response to the antiangiogenesis drug bevacizumab than cells with the C/T and T/T genotypes. Conclusions We suggest that VEGF could be used as a target for pterygium therapy in patients with the 936C>T genotype. [ABSTRACT FROM AUTHOR]

Aims To evaluate the efficiency of multimicroporous expanded polytetrafluoroethylene (e-PTFE) insertion in complicated multirecurrent pterygia. Methods A total of 62 eyes from 62 patients with a multirecurrent pterygium associated with symblepharon or motility restriction-related binocular diplopia were recruited. All eyes underwent pterygia excision followed by application of 0.033% mitomycin C, amniotic membrane transplantation and conjunctival limbal autograft. Multimicroporous e-PTFE was then inserted intraoperatively in 30 eyes between the transplanted amniotic membrane and the conjunctiva (group A), but not inserted in the other 32 eyes (group B). The main outcome measures were symblepharon formation, motility restriction, binocular diplopia, subjective score of conjunctival hyperaemia and postoperative pterygium recurrence. Results In the mean follow-up period of 17.2 ±2.3 months, symblepharon formation, motility restriction, diplopia and conjunctival hyperaemia were significantly improved after surgery in group A patients (p=0.000, 0.000, 0.008 and 0.000, respectively). Postoperative symblepharon formation, motility restriction and conjunctival hyperaemia were significantly less in group A compared to group B ( p=0.024, 0.027 and 0.000, respectively). After surgery, corneal recurrence developed in one eye (3.3%) from group A, which was significantly lower than the eight eyes (25%) from group B (p=0.027). Conclusions Multimicroporous e-PTFE insertion may provide a novel approach for treating intractable complicated multirecurrent pterygia. [ABSTRACT FROM AUTHOR]

AIMS: To investigate whether mycophenolic acid (MPA) exerts antifibrotic effects on pterygium fibroblasts (PFB) with and without stimulation with fibrogenic cytokines, and to compare the efficacy of MPA with mitomycin (MMC) and dexamethasone (DXM) on PFB and tenon fibroblasts (TFB). METHODS: TFB and PFB were obtained from tissue explants during strabismus or pterygium surgery. Proliferation of subconfluent fibroblasts±basic fibroblast growth factor (bFGF) (10 ng/ml) was assessed by using the (3H) thymidine-incorporation assay. Cell cultures were incubated with MPA, MMC or DXM. Apoptosis was evaluated by quantifying Annexin V and propidium iodide positive cells with flow cytometry. RESULTS: MPA showed a concentration-dependent inhibition of proliferation of PFB±bFGF as well as TFB±bFGF. The antiproliferative effect of MPA was comparable with that of MMC and DXM. Short exposure of PFB to MPA under profibrogenic conditions was significantly inhibitory. No apoptotic effect was found on TFB. CONCLUSIONS: MPA suppressed tenon and pterygium fibroblast proliferation in vitro under basal and profibrogenic conditions. It was comparable with MMC under long-term exposure, but MMC was more suppressive under short-term exposure. MPA may be safer than MMC due to a more specific mechanism of action and lack of cytotoxicity. Further investigation is warranted regarding MPA concentrations that will lead to a potent antiproliferative effect in vivo. [ABSTRACT FROM AUTHOR]

PURPOSE: To determine the prevalence and risk factors for pterygium in the adult Malay population of Singapore. METHODS: A population-based survey of Malays aged 40 to 79 years living in Singapore was conducted. Pterygium was diagnosed and graded clinically by slit-lamp examination as Grade 1 (atrophic), Grade 2 (intermediate) and Grade 3 (fleshy). We asked about potential risk factors such as socioeconomic status, cigarette smoking and outdoor activity. RESULTS: From a total of 4168 eligible subjects, 3280 (78.7%) were examined. There were 508 people with either unilateral (n=289) or bilateral (n=219) pterygium. The overall age-standardised prevalence rate of pterygia was 12.3% (95% CI 11.9% to 12.7%). In multiple logistic regression models, pterygium was independently associated with increasing age (OR, 1.3; 95% CI 1.1 to 1.4), male sex (OR, 1.9; 95% CI 1.5 to 2.6) and high systolic blood pressure (OR, 1.6; 95% CI 1.2 to 2.1). Grade 3 pterygium (n=92) was also associated with cholesterol in the fourth versus the first quartile (p=0.02) and with male sex. Outdoor occupation is only significant for severe pterygium (p=0.03). CONCLUSIONS: The prevalence of pterygium is 12.3% among urban Malays aged 40 years and older and higher than Chinese of similar ages in Singapore. Independent associations of pterygia with increasing age, male sex, outdoor occupations and systemic factors like blood pressure suggest a complex and multi-factorial aetiology for this condition. [ABSTRACT FROM AUTHOR]

Pterygium is an ocular surface disease of humans attributed to chronic ultraviolet-B exposure. Clinically, the condition involves invasive centripetal growth with associated inflammation and neovascularisation. Previous clinical studies focused primarily on the clinical characteristics and surgical management of pterygia and, because of this, the pathogenesis of pterygia remains incompletely understood. However, considerable progress in this area has been achieved, providing additional insight into this complex disease. This recent evidence implicates antiapoptotic mechanisms, immunological mechanisms, cytokines, growth factors, extracellular matrix modulators, genetic factors, viral infections and other possible causative factors. Limited investigation regarding differences in pathogenesis of primary and recurrent pterygia has been performed. We summarise many of these recent discoveries concerning the pathogenesis of pterygia and describe reported differences between primary and recurrent pterygia. [ABSTRACT FROM AUTHOR]

AIMS: Pterygium is a common corneal eye condition that can be disfiguring and may require surgery to avoid loss of vision. There are no population-based data on the prevalence or on risk factors among Latinos. METHODS: A population-based sample of 4774 self-reported Latinos age 40 years from randomly selected block groups in Nogales and Tucson, Arizona, USA, were enrolled in the study. Questionnaires were conducted in the home on risk factors. A clinical examination by an experienced ophthalmologist was carried out, and the presence of pterygium was diagnosed at the examination. RESULTS: The prevalence of pterygium was high (overall 16%). Men had a higher rate than women (23.7% versus 11.5%, respectively). Low income and low educational status were associated with higher odds of pterygium. Current smoking, and smoking dose, was protective for pterygium; this finding has now been reported from several studies. CONCLUSIONS: Pterygium rates were high in this population of Latinos. Socioeconomic status markers for increased exposure to sunlight suggest this may be the target of simple interventions to reduce the risk of pterygium in this ethnic population. [ABSTRACT FROM AUTHOR]

We describe a novel surgical technique for pterygium removal taking advantage of the properties of amniotic membrane and limbal epithelial stem cells. A total of 10 eyes underwent pterygium excision with amniotic membrane coverage of the bare sclera and placement of pieces of limbal epithelium in a linear fashion in the affected limbal area covered by a second amniotic membrane using fibrin glue. After up to 8 months of follow-up, there were no signs of early recurrence or sight-threatening complications. The minor ipsilateral simple limbal epithelial transplantation technique for the treatment of pterygium requires less tissue than the conventional conjunctival autograft, leaving healthy conjunctiva if needed for another procedure in the future and offers the advantages of epithelial stem cells, which in the long term may reduce the rate of recurrence significantly. [ABSTRACT FROM AUTHOR]

Aim: To compare the use of fibrin glue versus sutures for fixating conjunctival autografts in patients undergoing pterygium excision. Methods: Fifty patients (50 eyes) with primary pterygium were randomised to undergo pterygium surgery using either fibrin glue (25 eyes) or 8-0 Vicryl sutures (25 eyes) to attach the conjunctival autograft. The patients were followed up for 12 months. Outcome measures were postoperative patient comfort, duration of surgery and recurrence of pterygium. Results: In the fibrin glue group, the mean operation time was 15.7 (SD 2.4) mm (range 12-18 mm) and in the suture group (p<0.001) it was 32.5 (6.7) mm (range 25-40 mm). The intensity of the postoperative pain, foreign-body sensation, irritation and epiphora were significantly lower in the fibrin glue group than in the suture group (p<0.001). The intensity of itchy sensation at the first two postoperative visits was lower among patients in the fibrin glue group (five patients, 20%) than in the suture group (12 patients, 48%) (p<0.05). Two patients in the fibrin glue group had partial graft dehiscence; these grafts were successfully reattached with fibrin glue. At the end of follow-up, pterygium recurrence was observed in one eye (4%) in the fibrin glue group and in three eyes (12%) in the suture group (p<0.05). Conclusion: The use of fibrin glue in pterygium surgery with conjunctival autografting significantly reduces surgery time, improves postoperative patient comfort and results in a lower recurrence rate compared with suturing. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the comparative efficacy of direct conjunctival closure (DCC) and sliding conjunctival graft (SCG), with and without intraoperative mitomycin C 0.02% )MMC) for pterygium surgery. Methods: A comparative study consisting of a retropective chart review from our private practice was used to compare the outcome of patients who had undergone pterygium surgery. The eyes were classified according to the surgical technique performed. Group 1 was treated by DCC; Group 2 by DCC and intraoperative MMC; Group 3 by SCG; and Group 4 by SCG and intraoperative MMC. Outcome indicators were the appearance of recurrences and the time lapse before recurrences. Results: 482 eyes from 327 European Caucasian patients were included. The average follow-up was 19:7 months (SD 30.6). Group 1 comprised 209 eyes, Group 2107 eyes, Group 3101 eyes and Group 4 65 eyes. Recurrences appeared in 7.7% of the eyes in Group 1, 4.7% of the eyes in Group 2, 2% of the eyes in Group 3 and 1.5% of the eyes in Group 4. Conclusion: SCG reduces the appearance of recurrences in primary pterygium surgery. MMC seems to improve the results of surgery associated with DCC. SCG and DCC with MMC seem to achieve similar results. [ABSTRACT FROM AUTHOR]

Aims: To determine the prevalence, severity and risk factors associated with pterygium in adults in central Myanmar. Methods: Population-based, cross-sectional survey of the people 40 years and over residing in rural Myanmar. Pterygium was graded for severity (T1 to T3) by visibility of episcleral vessels, and the apical extent was recorded. An autorefractor was used to measure refractive error. Results: There were 2481. subjects identified, and 2076 (83.7%) participated. The prevalence of pterygium in either eye was 19.6% (95% confidence interval (CI) 16.9 to 22.2) and of bilateral pterygium 8.0% (95% CI 7.7 to 8.3(. Outdoor occupation was an independent predictor of pterygium (p<0.01). The mean apical extent from the limbus was 2.2 mm (95% CI 2.05 to 2.35). Higher-grade pterygia did not have a significantly greater apical extent (p = 0.35). The presence of pterygium was associated with astigmatism, (p = 0.01), and the amount of astigmatism increased as both the severity (p<0.01 ( and apical extent increased (p<0.01). Two people of the 84 people blinded in both eyes were bilaterally blind from pterygium (1.7%; 95% CI 0.2 to 6.1), and pterygium accounted for 2.2% (95% CI 0.7 to 5.0) of blindness in at least one eye. No participant had low vision in both eyes due to pterygium, but pterygium led to 0.8% (95% CI 0.3 to 1.6) of low vision in at least one eye. Pterygium was therefore associated with 0.4% (95% CI 0.04 to 1.3) of binocular visual impairment and 1.0% (95% CI 0.6 to 1.8) of visual impairment in a least one eye. Conclusions: There is a high prevalence of pterygium in central Myanmar, and the risk of developing this condition increases with outdoor occupation. Pterygium in this population is associated with considerable visual morbidity, including blindness. [ABSTRACT FROM AUTHOR]

Aim: The pterygium represents an invasion of a wing of altered ocular surface tissue into the normal cornea. The head itself is slightly elevated and white, which is the only site of firm adhesion to the globe. The mechanisms of cell proliferation and adhesion in pterygium epithelium, however, are unknown. The aim of this study was to analyse the expression of cell adhesion molecules in pterygium tissues. Methods: Six pterygia were surgically removed using the bare- sclera procedure, and two normal corneos and a normal bulbar con junctiva were also obtained. Formal infixed, paraf-fin-embedded tissues were analysed by immunohistochemistry with anti-E-cadherin and β-catenin antibodies. Results: Immunoreactivity for E-cadherin was not detected in the normal cornea and conjunctiva. In contrast, all corneal and conjunctival epithelial cells showed a weak homogeneous immunoreaction for β-catenin on the cell membrane. In the pterygium head, the thickness was relatively marked compared with the body, and normal conjunctival and corneal epithelia. E-cadherin as well as β-catenin was heterogeneously expressed in the cell membrane and cytoplasm of a variety of epithelial cells, whereas the expression was less marked in the body. Several epithelial cells showed intense nuclear immunoreactivity for β-catenin. Immunoreactivity of β-catenin, but not E-cadherin, was detected in only a few stromal cells, which were less marked than in epithelial cells. Conclusion: It is suggested that E-cadherin and β-catenin are concentrated in pterygium tissue, and are possibly involved with epithelial proliferation and adhesion. [ABSTRACT FROM AUTHOR]

Background: The pterygium is a growth onto the cornea of fibrovascular tissue that is continuous with the conjunctiva, whereas the mechanisms of cell proliferation in pterygium epithelium are unknown. Aim: To analyse the histopathology and the expression of cell cycle-related molecules in pterygium tissues. Methods: Seven pterygia were surgically removed using the bare-sclera procedure, and three normal bulbar con junctivas were also obtained. Formalin-fixed, paraffin-wax-embedded tissues were analysed by immunohistochemistry with anti-p27(KIP1), cyclin D1 and Ki-67 antibodies. Results: Conjunctival epithelium consisted of several layers of round cells with a few goblet cells. Nuclear immunoreactivity for p27(KIP1) was noted in many normal epithelial cells, where cyclin D1 and Ki-67-positive nuclei were intermingled. A variety of goblet cells were located in the superficial layer of the pterygium head as well as those of the body epithelia. Several pterygium epithelial cells were p27(KIP1) positive, whereas nuclear immunoreactivity for cyclin D1 and Ki-67 was detected in many epithelial cells. By contrast, immunoreactivity for p27(KIP1), cyclin D1 and Ki-67 was hardly detected in the pterygium stroma. Conclusion: It is suggested that pterygium growth and development are associated with the proliferation of epithelium, which is possibly involved in the expression of cell cycle-related molecules. [ABSTRACT FROM AUTHOR]

Background: This study was initiated after observation of some intriguing epithelial growth properties of contact lenses used as a bandage for patients after pterygium surgery. Aim: To determine the efficacy of culturing human ocular surface epithelial cells on therapeutic contact lenses in autologous serum with a view of using this system to transfer epithelial cells to patients with persistent corneal or limbal defects. Methods: Excess graft tissue resected from patients undergoing pterygium surgery (n = 3) consisting of limbal epithelium was placed on siloxane-hydrogel contact lenses (lotrafilcon A and balafilcon A). Limbal explants were cultured in media with 10% autologous serum. Morphology, proliferative capacity and cytokeratin profile were determined by phase contrast, light and electron microscopy, and immunohistochemical analysis. Results: Lotrafilcon A contact lenses sustained proliferation and migration from limbal tissue. Cells became confluent after 10-14 days and consisted of 2-3 layers with a corneal phenotype (CK3+/CK12+/CK19-) and a propensity to proliferate (p63+). Electron microscopy showed microvilli on the apical surface with adhesive projections, indicating that these cells were stable and likely to survive for a long term. Growth was not observed from limbal explants cultured on balafilcon A contact lenses. Conclusion: A method for culturing human ocular surface epithelium on contact lenses that may facilitate expansion and transfer of autologous limbal epithelial cells while avoiding the risks associated with transplanting allogeneic tissue has been developed. This technique may be potentially useful for the treatment of patients with limbal stem cell deficiency. [ABSTRACT FROM AUTHOR]

Aim: To determine whether amniotic membrane can be used as an alternative to conjunctival autograft after pterygium excision. Methods: 287 eyes with either primary or recurrent pterygium were included in this study. All eyes were randomised to undergo conjunctival autograft or amniotic membrane transplantation after pterygium excision by a single surgeon. 106 eyes in primary pterygium and 14 eyes in the recurrent group were treated with conjunctival autograft, and 148 eyes in primary pterygium and 19 eyes in the recurrent group were treated with amniotic membrane transplantation. Patients were followed up at 6 weeks and 6 months after operation. The main outcome measurement was recurrence rate after surgery. Results: In the conjunctival group, the recurrence rate was 12.3%, 21.4% and 13.1% for primary, recurrent and all pterygia, respectively. In the amniotic membrane group, the recurrence rate was 25.0%, 52.6% and 28.1% for primary, recurrent and all pterygia, respectively. The recurrence rate for all pterygia in the amniotic membrane group was significantly higher than that in the conjunctival group (p=0.003). Conclusions: Amniotic membrane graft had a higher recurrence rate than conjunctival autograft. However, it is an alternative choice, especially for advanced cases with bilateral heads or patients who might need glaucoma surgery later. [ABSTRACT FROM AUTHOR]

Background: Pterygium is a fibrovascular overgrowth from the conjunctiva onto the cornea. The pathogenesis of this common ocular surface disorder is not well understood and the only treatment is surgical removal. Methods: DNA microarray analysis of primary pterygium tissue was carried out using uninvolved con junctiva tissue as a comparison for gene expression levels. Real time polymerase chain reaction (PCR) was used to verify the mRNA level of expression for genes changed in pterygium. Western blot analysis and immunohistochemistry showed protein expression levels and the tissue distribution. Results: Microarray analysis revealed that mRNA levels of a number of genes were changed in primary pterygium. In particular the gene for insulin-like growth factor binding protein-3, (IGFBP3), which modulates the effects of insulin-like growth factor on cells was significantly decreased. Both the message and protein expression of IGFBP3 in pterygium were decreased compared to normal, uninvolved con junctiva. Conclusion: Decreased levels of IGFBP3 protein have been strongly correlated with the presence of cancer. Identification of the low level of expression of IGFBP3 in pterygium suggests that the pathway controlling cell proliferation has lost an important control mechanism, which may explain the continued growth of pterygium. [ABSTRACT FROM AUTHOR]

Aim: To evaluate long term complications after pterygium excision with mitomycin C (MMC) application. Design: Prospective non-comparative interventional case series. Participants: Ninety nine patients who underwent pterygium surgery and participated in a controlled study for efficacy of MMC for pterygium surgery between 1989 and 1994. Methods: Patients who were located and agreed to come for examination underwent a complete eye examination. The bare sclera area, in particular, was examined for possible complications. The main outcome measures were anatomical findings in area of MMC application. Results: Forty three eyes of 43 patients were examined. Sixty three per cent of patients had pterygium surgery with intraoperative application of 0.02% MMC for 5 minutes and 37% of patients received MMC 1 % or 2% drops four times daily for 2 weeks postoperatively. In three patients, pterygium recurred within 18 months. The only complication was mild conjunctival avascularity in areas of pterygium excision in 30% of patients. Conclusion: Long term evaluation revealed that the use of MMC in pterygium surgery is safe, but for a strict selection of patients, controlled use of MMC and long term follow up are required. [ABSTRACT FROM AUTHOR]

Aim: Evaluation of the benefits of a new technique for pterygium surgery with respect to postoperative pain and surgery time. Methods: A prospective randomised clinical trial was carried out in 43 patients. 43 eyes were operated for primary nasal pterygium. Autologous conjunctival graft taken at the superotemporal limbus was used to cover the sclera after pterygium excision. After randomisation, in 20 patients the transplant was attached to the sclera with a fibrin tissue adhesive (Tisseel Duo Quick) and in 23 patients with absorbable sutures (7-0 Vicryl Rapid). The Mann-Whitney test was used as statistical analysis. Postoperative pain was graded according to the visual analogue scale (VAS) twice daily during the first week after surgery. Surgery time was noted from the first incision until the lid speculum was removed. Results: The average pain was significantly lower when glue had been used, p<0.05. Average surgery time was 9.7 minutes (range 6-13) For glue and 18.5 minutes (range 12-30) for sutures, p<0.001. No complications occurred. Conclusion: Using glue instead of sutures when attaching the conjunctival transplant in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly. [ABSTRACT FROM AUTHOR]

Aim: To determine prevalence rates, severity, and risk factors for pterygium in adults in provincial Indonesia and to validate a clinical grading scheme in a population based setting. Methods: A population based prevalence survey of 1210 adults aged 21 years and above was conducted in five rural villages and one provincial town in Riau province, Sumatra, Indonesia, an area near to the equator. A one stage household cluster sampling procedure was employed: 100 households were randomly selected from each village or town. Pterygia were graded for severity (T1 to T3, by visibility of episcleral vessels) and the basal and apical extent measured by an ophthalmologist (GG) with a hand held slit lamp. Refraction was measured by hand held autorefractor (Retinomax). Face to face household interviews assessed outdoor activity, occupation, and smoking. The participation rate was 96.7%. Results: The mean age was 36.6 years (SD 13.1), 612 were male. The age adjusted prevalence rate of any pterygium was 10.0% (95% confidence intervals (CI) 8.2 to 11.7) and of bilateral pterygia was 4.1% (95% CI 2.9 to 5.3). There was a significant dose-response relation with age (2.9% (95% CI 0.4 to 5.8) for 21-29 years versus 17.3% (95% CI 10.4 to 24.2) 50 years and above; p for trend <0.001) and occupations with more time outdoors (p for trend = 0.02). This was true for both sexes, all grades of lesion (T1 to T3), and bilateral disease. A multivariate logistic regression model showed pterygium was independently related to increasing age and outdoor activity 10 years earlier. The mean basal diameter = 3.3 mm (SD 1.51, range 0.1-9.5) and extent from limbus = 1.4 mm (SD 1.18, range 0.18.0). Higher grade pterygia were larger for basal and apical extent (p for trend <0.001). The presence of pterygium was associated with astigmatism (defined as cylinder at least -0.5 dioptres (D); p <0.001). This association increased with increasing grade of lesion (p for trend <0.001). Median cylinder for those... [ABSTRACT FROM AUTHOR]

Background: Pterygium is a disease of unknown origin and pathogenesis that might be vision threatening. It is characterised by a wing-like conjunctival overgrowth of the cornea. Several studies have investigated human papillomavirus (HPV) as a risk factor for the development of pterygia, but the results are inconclusive. Aim: To investigate a large sample of pterygia for the presence of HPV in order to clarify the putative association between pterygia and HPV. Methods: 100 specimens of pterygium from Danish patients and 20 normal conjunctival biopsy specimens were investigated for the presence of HPV with PCR technique using β-globin primers to access the quality of the extracted DNA and the HPV primers MY09/11 and GP5+/6+. HPV-positive specimens underwent subsequent HPV typing with type-specific HPV primers and further investigation with DNA in situ hybridisation (ISH). Results: 90 of 100 investigated pterygia proved suitable for HPV analysis by PCR. As β-globin could not be amplified, 10 specimens were excluded from the study. 4 of 90 pterygia harboured HPV. HPV type 6 was identified in all four HPV- positive pterygia. The 20 normal conjunctival biopsy specimens were β-globin positive and HPV negative. All four pterygia that were HPV type 6 positive were DNA ISH negative. Conclusions: The low presence of HPV DNA in pterygia does not support the hypothesis that HPV is involved in the development of pterygia in Denmark. [ABSTRACT FROM AUTHOR]

Background: Mitomycin C (MMC) and limbal conjunctival autograft (LCAU) are two known useful adjuvants in the prevention of pterygial recurrence. This study was conducted to compare the outcome of these two treatments. Methods: Prospective study on consecutive cases of primary pterygium (February 2001 to March 2002) randomised into two adjuvant groups: (1) intraoperative 0.02% MMC for 5 minutes or (2) LCAU. Patients were followed for recurrence (defined as fibrovascular tissue invading the cornea >1.5mm) and complications for a period of one year. Results: 115 eyes in 114 patients who completed the study were randomised to receive MMC (n=63) and LCAU (n=52). There were 10 recurrences (15.9%) in the MMC group and only one recurrence (1.9%) in the LCAU group. There was a statistically significant difference in the recurrence rate between the two groups (p =0.04). There were a total of three conjunctival cysts, three symblephara, one granuloma, and one dellen. No other visually significant complications were encountered in either group. Conclusion: Although LCAU resulted in better one year success rates, it is technically more difficult and inapplicable in cases with previous limbal disturbance. Simple excision followed by MMC or LCAU are both safe and acceptable adjuvants for pterygium excision. Choice of adjuvant should be carefully made based on assessment of recurrence risk, local practices, and surgeon's expertise. [ABSTRACT FROM AUTHOR]

Aims: To determine prevalence of pterygium, its role as main cause of unilateral and bilateral visual impairment and blindness and its impact on refractive errors from adults living in a high ultraviolet exposure area in the Brazilian Amazon Region., Methods: Cluster sampling was used in randomly selecting subjects ≥45 years of age from urban and rural areas of Parintins city. Eligible subjects were enumerated through a door-to-door household survey and invited for an eye exam including refraction. Pterygium was assessed considering location (nasal, temporal or both) and size (<3 mm or ≥3 mm reaching or not pupillary margin)., Results: A total of 2384 persons were enumerated and 2041 (85.6%) were examined. Prevalence of pterygium was 58.8% (95% CI 53.8% to 63.7%) and associated with male gender (OR=1.63; 95% CI 1.37 to 1.94; p=0.001), while higher education was a protective factor (OR=0.63; 95% CI 0.44 to 0.92; p=0.018). Older age and rural residence were associated with pterygium ≥3 mm reaching or not pupillary margin, while higher education was a protective factor for pterygium ≥3 mm reaching pupillary margin. Prevalence of pterygium as cause of visual impairment and blindness was 14.3% and 3.9%, respectively. Significantly higher hyperopic refractive errors were found in eyes with pterygium ≥3 mm reaching or not pupillary margin., Conclusions: Pterygium was highly prevalent and the second cause of visual impairment and blindness after provision of refractive correction. Risk factors for pterygium were male gender, advanced age, lower education and rural residency. Strategies to provide pterygium early detection and proper management should be considered by healthcare authorities in this population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

The author reflects on research which has investigated the cause of pterygium of the eye, which refers to an abnormal wing-like growth which is seen most commonly on the conjunctiva and cornea. He suggests that research has found that pterygium appears to be an ophthalmoheliosis or sun-related eye disease. He argues that epidemiological, clinical and laboratory findings suggest a multifactorial process leading to pterygium formation, possibly involving a two-hit mechanism.

AIMS: To describe the use of subconjunctival bevacizumab or ranibizumab, an approved antivascular endothelial growth factor for wet macular degeneration, in halting the inflammation of a pterygium or a partially excised pterygium. METHODS: Case reports. RESULTS: Prompt regression of conjunctival microvessels in the pterygial bed was documented 1 week after a single subconjunctival injection of ranibizumab (one case) or bevacizumab (two cases). No side-effects were noted over 13 months of follow-up in the first case, 6 months in the second case and 1 month in the third case. CONCLUSION: Selective blockade of vascular endothelial growth factor was effective in causing regression of conjunctival microvessels in three eyes with inflamed pterygium or residual pterygia. [ABSTRACT FROM AUTHOR]