Clinical and autofluorescence findings in eyes with pinguecula and pterygium

Purpose: To assess the autofluorescence size and properties of pterygium and pinguecula by anterior segment autofluorescence (AS-AF) imaging and demonstrate the difference of autofluorescence size presented in AS-AF imaging compared to the extend size of the conjunctival lesion measured by anterior segment slit-lamp photography (AS-SLE). Methods: Twenty-five patients with primary pterygium and twenty-five with pinguecula were included in the study. In addition, 25 normal subjects were also enrolled as the control group. The AS-AF characteristics of pterygium and pinguecula lesions were analyzed. The size of lesions displayed in the AS-SLE photography versus the AS-AF images were also compared. AS-AF images were obtained using a Heidelberg retina angiograph which focused on the anterior segment. AS-SLE photography was acquired using a digital imaging system (BX900 HAAG STREIT). Results: There were 44 (58.7%) male and 31 (41.3%) female patients; 19 (76%) and 20 (80%) patients had bilateral pterygium and pinguecula, respectively. All pinguecula lesions reflected hyperautofluorescence pattern in the AS-AF imaging. In 24 (96%) patients, the hyperautofluoresecence pattern was larger than the size of the clinical lesions displayed with the AS-SLE photography. Twenty-one (84%) patients with pterygium reflected a hyperautofluorescence pattern in AS-AF images; in one (4%) patient, the hyperautofluorescence pattern was larger than the clinical lesion size and four (16%) patients had no autofluorescence patterns in the AS-AF images. In the control group, in 14 (56%) subjects, a hypoautofluorescent pattern was revealed in the conjunctiva in AS-AF images. However, in 11 (44%) patients, hyperautofluorescence patterns were detected. Conclusion: AS-AF is a useful modality to monitor vascularization in conjunctival lesions. Pingueculae and pterygium show hyperautofluorescence in AS-AF imaging. The real size of the pinguecula lesions may be estimated with AS-AF characteristics, mostly presenting larger than the area size in AS-SLE photography. The autofluorescence size of the pterygium is smaller than the extent of visible pterygium in slit-lamp photography.

Clinical Characteristics of Patients with Pinguecula between 20 and 39 Years of Age

PURPOSE: To describe the characteristics of patients with pinguecula between the ages of 20 and 39. METHODS: Thirty-two patients who visited our hospital between February 2013 and November 2013 for pinguecula were enrolled in the study. The clinical characteristics were evaluated by the location, size, shape, elevation, color, vascularization and the grade of pingueculae. RESULTS: Ninety-eight pingueculae were found in the 32 patients, 58 (59.18%) pingueculae on the nasal side, and 40 (40.82%) pingueculae on the temporal side. The mean grade of pingueculae of the nasal side was 1.19 +/- 0.40 and on the temporal side was 1.15 +/- 0.43. Compared with the temporal side, pingueculae on the nasal side were more frequent (p = 0.032). The size, color, shape and vascularization of nasal and temporal pingueculae were not significantly differentiated. Medical history, tear film break-up time, Schirmer test, history of contact lens wearing, refractive surgery, occupational activity and residence were not correlated with the grade of pingueculae. However, ocular surface disease index score was correlated with the grade of nasal pingueculae (p = 0.01). CONCLUSIONS: The pingueculae of the nasal side were more frequent than of the temporal side in patients between 20 and 39 years of age, and dry eye disease with tear film instability was also present. The ocular surface disease index score increased with the grade of nasal pingueculae.

The Pathologic Characteristics of Pingueculae on Autofluorescence Images

PURPOSE: To analyze the autofluorescence (AF) properties of pinguecula using cobalt-blue and yellow filters and to investigate the nature and pathogenesis of pingueculae using histochemical and immunohistochemical staining. METHODS: Fifty pingueculae in 40 patients were included in this study. AF of the pingueculae was observed and analyzed using a cobalt-blue filter with an additional yellow filter on a slit-lamp. Hematoxylin-eosin and immunohistochemical stainings were performed on surgical specimens of pingueculae that were prepared from each patient. Immunohistochemical staining included Congo red, Oil Red O, periodic acid-Schiff (PAS), Masson's trichrome, transglutaminase-2 (TG-2), mesenchymal stem cell markers CD29 (beta-1-integrin), and CD34. RESULTS: AF images revealed hyper-AF in the pinguecula area. The AF lesions of pingueculae showed superficial punctuate erosions and avascular lesions. Deposition of eosinophilic and amorphous materials in the subepithelial layer of the pinguecula were observed on hematoxylin-eosin staining. Historeactivities to Congo red, PAS, Oil Red O, alcian blue, and Masson's trichrome were not detected, but immunoreactivities to CD29, CD34, and TG-2 were detected in the pingueculae with AF. However, CD29, CD34, and TG-2 were not detected in the pingueculae without AF. CONCLUSIONS: The AF of pingueculae may be related to CD29, CD34, and TG-2. We suggest that pingueculae with AF have a different pathogenesis compared to pingueculae without AF.

Clinical Features of Pinguecula in North-Western Gyeonggi Province

PURPOSE: To investigate the clinical features of pingueculae in North-western Gyeonggi Province. METHODS: In this prospective study, we determined the clinical features of pingueculae for 120 patients who visited our hospital due to pinguecula-related symptoms between October 2011 and May 2012. RESULTS: Among the 374 pingueculae of 120 patients, 208 (56%) pingueculae were found on the nasal side of the conjunctiva and 166 (44%) on the temporal side. The grade of the pingueculae on the temporal conjunctiva was 0.81 +/- 0.626 and was 1.18 +/- 0.648 on the nasal conjunctiva, which was higher (p < 0.001). Pingueculae on the nasal conjunctiva showed greater elevation than on the temporal side (p < 0.001). The horizontal and average diameters of the pingueculae on the nasal and temporal conjunctiva showed no significant difference, but the vertical diameters were 2.40 +/- 0.88 mm and 2.14 +/- 0.91 mm, respectively, showing the vertical diameter on the nasal conjunctiva was significantly greater (p < 0.044). Moreover, the horizontal diameter of each pinguecula was greater than the vertical diameter (p < 0.003). CONCLUSIONS: The average grade of pingueculae in North-western Gyeonggi Province increased with age. Compared to the temporal pingueculae, the nasal pingueculae were more protrudent in shape and had higher grades. Furthermore, each pinguecula was oval-shaped with a larger horizontal than vertical diameter. The pingueculae on the temporal side were flatter and more oval-shaped.

Changes of Ocular Surface and Tear Film in Patients with Pinguecula and Pterygium

PURPOSE: This study was performed to evaluate the parameters of tear function and ocular surface in patients with pinguecula and pterygium. METHODS: The corneal sensitivity test (CST), tear break-up time (BUT), basal tear secretion test, fluorescein staining, rose bengal staining, tear clearance test, and conjunctival impression cytology were evaluated in patients with unilateral pinguecula and pterygium. The results were also evaluated according to the severity of pterygium. RESULTS In patients with pinguecula, BUT (P=0.03) and goblet cell density (P<0.01) were decreased, while the rose bengal staining score (P=0.01) was increased significantly. In patients with pterygium, CST (P=0.01), BUT (P<0.01), and goblet cell density (P<0.01) decreased, and the fluorescein staining score (P<0.01), rose bengal staining score (P<0.01) and grade of conjunctival metaplasia (P<0.01) increased significantly. In comparison with mild pterygium, moderate pterygium demonstrated decreased CST (P=0.01) and BUT (P=0.01), and an increased rose bengal staining score (P=0.04). CONCLUSIONS: The tear films and ocular surface changes in patients with pinguecula and pterygium are worse than in control group. Also, there is close correlation between the severity of pterygium and dry eye condition.

Changes of Ocular Surface and Tear Film in Patients with Pinguecula and Pterygium

PURPOSE: This study was performed to evaluate the parameters of tear function and ocular surface in patients with pinguecula and pterygium. METHODS: The corneal sensitivity test (CST), tear break-up time (BUT), basal tear secretion test, fluorescein staining, rose bengal staining, tear clearance test, and conjunctival impression cytology were evaluated in patients with unilateral pinguecula and pterygium. The results were also evaluated according to the severity of pterygium. RESULTS In patients with pinguecula, BUT (P=0.03) and goblet cell density (P<0.01) were decreased, while the rose bengal staining score (P=0.01) was increased significantly. In patients with pterygium, CST (P=0.01), BUT (P<0.01), and goblet cell density (P<0.01) decreased, and the fluorescein staining score (P<0.01), rose bengal staining score (P<0.01) and grade of conjunctival metaplasia (P<0.01) increased significantly. In comparison with mild pterygium, moderate pterygium demonstrated decreased CST (P=0.01) and BUT (P=0.01), and an increased rose bengal staining score (P=0.04). CONCLUSIONS: The tear films and ocular surface changes in patients with pinguecula and pterygium are worse than in control group. Also, there is close correlation between the severity of pterygium and dry eye condition.

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)

Etiology of the pterygium

The author suppose the etiology of the pterygium as combination of following various factors. 1) Irritation of the sun light, wind and dust. 2) Pterygium is frequently encroachment of a pinguecula onto the cornea. 3) Continuous movement of the eye may influence upon the formation of the pterygium. 4) Constiant rubbing of the semilunar fold against bulbar conjunctiva of the internal palpebral fissure. 5) Conjunctival fold due to resistance of the caruncle in ocular movement cause the pressure to the medial limbus. This fact may largely influence upon the formation of the pterygium. 6) Frequent mechanical irritation to the internal palpebal fissure in washing one's face and other daily works. 7) Accumulation of the tear film and dusts on the inner canthal region constantly irritate bulbar conjunctiva. 8) Subconjunctival connective tissue and subconjunctival hypertrophied tissue (a kind of subconjunctival pathologic connective tissue) near the caruncle play great role of the formation and recurrent of the pterygium. This hypothesis based on the fact that extensive and large amount of removal of the subconjunctival pathologic connective tissue according to the author's new operation method revealed complete prevention of the recurrence of pterygium. 9) Incidence of the pterygium on the medial side is over 98% in spite of same condition of the lateral and medial conjunctiva. The author suppose this fact is due to above prescripted various factors.

A New Method of Operation for pterygium (Report 2)

The author had published the first report of the above subject in May, 1964. The mode of operation was detailly explained, and the discussion was given briefly at last report. The conclusion are as follows. 1. Pterygium is a benign condition in itself. so that it's operation is very simple and easy. 2. The operated eye became good cosmetic result, and became occasionally clearer than the sound eye through this operation. 3. Regardless of primary or recurrent one, or the size, similarly good result was obtained to after pterygiam operation. As Pinguecula is seemed to be very close to pterygium, Also good results was obtained through same operative procedures as pterygium. 4. Scarcely recurrency was found if one do not make a fault in this operation.