Pterygium management and comparison of different surgical approaches with supportive treatment in Rural Maharashtra

Background:Numerous surgical procedures and changes have been ineffective in preventing the recurrence of pterygium. Aprospective clinical observational analysis of 205 individuals with primary pterygium was conducted where patients were treated with various surgical procedures. The patients were observed for two to five years in order to examine the frequency of recurrences and consequences. Result: Patients were divided into four groups and treated using a variety of surgical methods. Straightforward excision of pterygium was the treatment of choice in group 1. Excision with conjunctival rotation pedicle graft was used on patients in Group 2. Excision and conjunctival autograft were used to treat Group 3 patients. Patients in Group 4 received excision and a 0.02 percent solution of mitomycin c drops as a postoperative treatment. Age varied from 22 to 58, with a median of 34. All four groups had an equal number of men and women. Hemorrhage, astigmatism, symblepheron, foreign body feeling, and a corneo-scleral ulcer were among complications that were reported. There were 12 percent complications in group 1, 16 percent complications in group 2, 6 percent complications in group 3, and 8 percent complications in group 4. Criteria for recurrence was defined as the regrowth of fibrovascular tissue or the appearance of an aesthetic flaw. It's 30 percent for group 1; 14 percent for group 2, 9 per cent for group 3, and 8 per cent for group 4. Conclusion: The least rate of recurrence was noted in patients of Group 4 who had pterygium excision with postoperative mitomycin c instillation, and complications were least common in patients in Group 3 who had pterygium resection with conjunctival autograft

Application of fibrin glue in conjunctival autograft surgery in rabbit pterygia model / 中华实验眼科杂志

BackgroundPterygia is a clinical common disease.A lot of surgical methods are developed to decrease the recurrence rate.Resent years,the application of fibrin glue is receiving more and more attention.Objective This study was to explore the effects of fibrin glue in decreasing inflammatory irritation and its mechanism. Methods Pterygia models were created in 12 clean rabbits by exsection of limbal tissue and topical administration of 1.25％ diluted hydrochloric acid,and then the conjunctival autograft surgery was performed in the experimental rabbits.The conjunctival flap was sutured in the left eyes,and the conjunctival wound was closed using fibrin glue in the right eyes.The operation duration for each group was documented and compared.The irritation sign was examined under the slit lamp in all the rabbits 1 week and 4 weeks respectively.The expressions of vascular endothelial growth factor (VFGF) and basic fibroblast growth factor (bFGF) proteins in the conjunctiva tissue were detected by immunochemistry,and the expressions of VFGF mRNA and bFGF mRNA in the conjunctival tissue were determined by reverse transcription polymerase chain reaction (RT-PCR).Results The operative duration was (21.3±0.2) minutes in suture group and( 10.1 ±0.1 )minutes in the fibrin glue group with a significant difference between two groups( t =102.242,P＜0.05 ).From 1 week through 4 weeks,the hyperemiain degree was obviously slight in fibrin glue group compared with suture group.Immunochemistry showed that VEGF and bFGF proteins were expressed mainly in the cytoplasm of conjunctival epithelium layer.The positive response intensity was weaker in the fibrin glue group than in suture group 1 week and 4 weeks after operation.RT-PCR revealed that the expression level of VEGF mRNA was significantly lower in fibrin glue group than in suture group,and the VEGF mRNA was gradually decreased with the time lapse ( Fgroup =174.443,P =0.000 ; Ftime =231.459,P =0.000 ).The similar outcomes were found in the expression of bFGF mRNA(Fgroup=41.727,P=0.000;Ftime=55.417,P=0.000). ConclusionsThe use of fibringluecanshortentheoperationdurationandreducepostoperationinflammatoryreaction.The downregulation of VEGF and bFGF in tissue is the possible mechanism of remitting irritation sign,which allows a reduce of the recurrence rate of pterygia.

Prevalencia de pterigio, pingüecula hiperplasia conjuntival entre trabajadores de una empresa cementera de Bogotá / Prevalence of pterygia, pingueculae, and conjuntival hiperplasia among cement workers from Bogotá

Un estudio exploratorio retrospectivo fue realizado con 195 trabajadores de una empresa cementera, con el fin de explorar la asociación entre la exposición a polvo de cemento y la ocurrencia de pterigio, pingûecula e hiperplasia conjuntival. En 1998 una optómetra realizó los exámenes físicos, encontrando que las prevalencias de alteraciones conjuntivales en la población estudiada fueron: 37,4 % para la pingûecula, 23,6 % para la hiperplasia conjuntival y 19 % para el pterigio. Los trabajadores fueron clasificados en tres grupos según los niveles de exposición encontrados en la inspección del lugar de trabajo realizado por un especialista en salud ocupacional. Los resultados de la comparación de estos grupos sugieren una asociación entre la exposición a polvo de cemento y el pterigio (RPa: 9,8; IC95%: 1,4-68,8). Se plantea la necesidad de realizar nuevos estudios para mejorar el conocimiento de la etiología de las alteraciones conjuntivales, así como realizar los cambios en el ambiente laboral e implementar el uso de elementos de protección ocular.(AU)

A retrospective exploratory study was realized with 195 cement workers to explore the association between cement dust exposure and the occurrence of pterygia, pingueculae, and conjuntival hiperplasia. An optometrist examined the population in the enterprise during 1998. The prevalences of conjuntival alterations were: pingueculae 37,4 %, conjuntival hiperplasia 23,6 %, and pterygia 19 %. The workers were classified in three groups according to exposure levels determined by an occupational health specialist. The findings of the group comparison suggest an association between cement dust exposure and pterygia (PRa: 9,8; IC95 %: 1,4-68,8). New studies are required to improve the knowledge about the etiology of conjuntival alterations. Changes in the occupational environment and personal protective elements are recommended to guarantee ocular health.(AU)

Conjunctival autograft transplantation for recurrent pterygia

The pterygia is an ocular diseases with a multifactorial etiology and is found more commonly in tropical areas such as Vietnam. The surgical treatment of pterygia is still a big challenge to opthalmologists due to high rate of its recurrent. In this study we performed the conjunctival autograft transplantation (CAT) on 66 patients (81 eyes) of recurrent pterygia with dramatically success: 79 eyes (97.5%) have excellent and good results. There are 2 eyes (2.5%) have light proliferation of fibrovascular tissue in the border of graft. This study showed that CAT is good procedure for preventation of recurrent pterygium and should be applied popularly in the departments of ophthalmology of the provinces.

Expression of Vascular Endothelial Growth Factor and iNOS in Pterygia

To evaluate the expression of vascular endothelial growth factor (VEGF) in pterygia and seek the reciprocal relationships between VEGF and nitric oxide (NO) in development of pterygia. Conjunctiva sampled during conjunc-tival transplantation of pterygial operation and pterygia were used in this study. OCT compound-fixed-cryopreserved tissues consisted normal conjunctiva and pterygia were used to study the expression of VEGF and iNOS with immunohistochemistry. For confirmation of NOS activity, NADPH-diaphorase staining was done. ELISA for detection of VEGF amounts was performed. The expression of VEGF and iNOS were revealed in the epithelium of pterygia, although there were not expressed in the epithelium of normal conjunctiva. The epithelium of pterygia was stained with NADPH-diaphorase. The results of ELISA showed the higher amount of VEGF inpterygia compared with conjunctiva. These findings suggest that VEGF and NO play an important role in fibrovascular development of pterygia.s

The pterygium excision by the conjunctival autograft combining with the single mitomycin C application

The purpose of this study was to evaluate the efficacy of conjunctival autograft with single intraoperative application of MMC 0.04% within 3 minutes in primary and recurrent pterygium and to compare this method with other’s. Sixty three patients (68 eyes: 50 eyes with primary and 18 eyes with recurrent pterygium) underwent pterygium excision with conjunctival autograft and single application of MMC 0.045/3 minutes. Patients were followed from 3 to 12 months after operation. Results: recurent rate of 1.96% (1 eye) was observed in the group of recurrent pterygium. There were 2 cases of superficial punctuate keratitis. Conclusion: this study indicates that intraoperative administration of a single dose of 0.04% MMC with conjunctival autograf is an effective treatment for prevention of recurrence of pterygium