Effects of Mitomycin C in Early Conjunctival Inflammation after Pterygium Surgery.

PURPOSE: The purpose of this study was to compare inflammatory events and graft characteristics 1 month and 6 months after conjunctival limbal autograft (CLAU) with and without intraoperative mitomycin C (MMC). METHODS: This study included 69 eyes of 69 patient's eyes with pterygium. Clinical data concerning patient demography, preoperative examination including pterygium morphology, recurrence clinical assessment, and complications after CLAU with (MMC+) and without (MMC-) intraoperative MMC were all registered at 1 month and 6 months after surgery. RESULTS: Thirty-five eyes were included in MMC+ and 34 in MMC-. Preoperative data were similar in both groups (Student's t test and Fisher's exact test; p > 0.05). Thirty-four (49.6%) eyes in the whole sample showed at least one inflammatory complication at 1 month after surgery. MMC- group showed a significantly higher number of cases with complications (p < 0.001; Chi2 test) (MMC+ 28.5%; MMC- 70.5%). No patients presented clinical recurrence at 1 month after surgery. The examination revealed a higher incidence of clinical hyperemia surrounding the surgical site and graft contraction on the host site on the MMC- group, both with statistical signification (p < 0.001; Chi2 test). Although the hemorrhages were less frequent in the MMC- group, there were no significant differences between the two groups (p > 0.05; Chi2 test). Pyogenic granuloma developed at the surgical site in three eyes (4.37%), two of those granulomas were at the MMC- group (p > 0.05). Tendency for recurrences was significantly different between both groups (p = 0.0001; Fisher's exact test) at the end of 6 months. Thirteen (38%) eyes showed recurrence in MMC- and no cases were displayed in MMC+. Presence of at least 1 inflammatory event was only seen in 16 (23%) cases, all of them in MMC-. Specifically, 15 (44%) eyes showed hyperemia and one (3%) eye presented conjunctival hemorrhages. No new cases of pyogenic granuloma or graft contraction were seen at this time point in both groups. Hyperemia was the only specific event with significant differences between MMC- and MMC+ (p = 0.0001; Fisher's exact test) at 6 months after surgery. CONCLUSION: The eyes receiving intraoperative MMC after CLAU seem to present less hyperemia and graft contraction after surgery than those that did not receive MMC as an adjuvant factor. Intraoperative MMC could be associated with a lower recurrence rates.

Determining Factors for Fast Corneal Sensitivity Recovery After Pterygium Excision.

PURPOSE: To establish determining factors for fast corneal sensitivity (CS) recovery after pterygium excision. METHODS: Thirty-two eyes of 14 males and 18 females with primary nasal pterygium were recruited. Differences in CS (in the 4 quadrants and the center using a Cochet-Bonnet esthesiometer), pterygium corneal area (PCA), tear osmolarity, tear break-up time, Schirmer test, and ocular symptoms were analyzed before and 1 month after lesion excision. The relationship between CS recovery (difference between the 2 time points; CS1 - CS0) and the other features was assessed. RESULTS: All the studied locations exhibited normal (6 cm) or near-normal mean CS at the 2 time points, except a tendency for moderate hypoesthesia in nasal CS0 (median 4.5; range: 1.5-6.0 cm). Point by point comparison revealed significant postoperative improvements in nasal location (P = 0.008; Wilcoxon signed-rank test) with normal values in 17 eyes (53%) and a median CS1 = 5.0 cm (2.5-5.5 cm) in 15 eyes with no complete recovery. No significant correlation was found between CS0 and the studied variables, and CS1 was only significantly correlated with PCA (rho: -0.441; P < 0.05). CS recovery also showed significant correlation with PCA (rho = -0.516; P < 0.01). CONCLUSIONS: CS recovery after pterygium excision showed important variability, and the only studied factor that seems to be determinant could be PCA. It would be advisable to operate when the lesion is relatively small, with lower surgical injury and faster and complete recovery, thus protecting ocular surface homeostasis.

What biomarkers explain about pterygium OCT pattern.

BACKGROUND: Optical coherence tomography (OCT) has become a very useful tool to study in vivo different ocular structures and to improve differential diagnosis and management of many ocular pathologies. This study aims to identify pterygium alterations that trigger characteristic OCT images, and analyze if this pattern correctly demarcates lesion boundary. METHODS: Thirty-two patients, 22 men, and ten women, aged between 26 and 56 (mean age 40.5 ± 6.9) with symptomatic primary pterygium were recruited. After excision, lesion images were obtained by high-definition OCT. Specimens were stained with hematoxylin­eosin (H&E), antivimentin for all mesenchymal origin cells and altered limbal basal cells, CD45 for lymphocyte and macrophage cells, CD1a for Langerhans cells, and S100 for melanocyte and Langerhans cells. RESULTS: The typical OCT wedge-shape hyperreflective mass was evident only by vimentin antibody and included, mainly, fibroblasts but also immune cells (verified by CD45) in a rich network of collagen fibers. The mass apex, often extended centripetally as a thin subepithelial line, hyperreflective by OCT, was formed by a row of fibroblasts under an apparently intact Bowman's layer, as vimentin samples revealed. Hyperreflective epithelium overlying the mass showed a great number of vimentin-positive infiltrated cells such as melanocytes, Langerhans cells, and lymphocytes (identified by the other biomarkers). H&E staining revealed the presence of goblet cells. Nevertheless, only vimentin staining revealed the presence of altered basal cells above partially dissolved or apparently intact Bowman's layer, coinciding in this last case with the fibroblast subepithelial line. In most of the cases (72 %), the altered cells occupied a basal segment shorter than the fibroblast subepithelial line but in some specimens, these cells exceeded the fibroblast line length. CONCLUSIONS: This study demonstrated the great visual accordance between pterygium OCT images and vimentin staining. Alteration in collagen arrangement, infiltration of inflammatory cells, and fibroblast subepithelial line in the lesion apex were the main histological changes responsible for the anomalous hyperreflectivity of the OCT pattern. By contrast, altered basal cells located in the basal epithelial layer of the pterygium head could not be detected by OCT, which might generate lesion size underestimation.

Conjunctival Short-term Evolution after Pterygium Excision.

PURPOSE: To analyze conjunctival cytological features 1 month after pterygium excision using limbo-conjunctival autograft (LCA) with and without intraoperative mitomycin C and to assess tissue short-term evolution in both situations. METHODS: Fifty-nine primary nasal pterygia from 59 patients were excised with LCA. Twenty-nine were treated with intraoperative mitomycin C 0.02% (MMC+) and 30 were treated without it (MMC-). Impression cytology was performed in nasal and temporal conjunctiva before and 1 month after the excision. Goblet cell density (GCD) and nucleus-to-cytoplasm nongoblet epithelial cell ratio were quantified. RESULTS: Surgical strategy comparisons (intergroup comparisons): All the preoperative data were, in mean, within the reference range, except for a slight goblet cell hyperplasia in the area of the lesion in MMC+ but no significant differences were found between the groups (p = 0.079 for GCD and p = 0.245 for nucleus-to-cytoplasm ratio; analysis of variance). Clinically relevant differences after surgery were only shown in nasal GCD that was significantly lower in MMC+ than in MMC- (p = 0.000; analysis of variance), with the mean value in MMC+ slightly below normal values whereas that in MMC- remained normal. Tissue evolution (intragroup comparisons): No clinically relevant changes were found in MMC-. Data from MMC+ displayed no changes 1 month after surgery, except for nasal GCD that showed a significant reduction (p = 0.000; paired t test). Nevertheless, this GCD decrease was more modest than that previously described using mitomycin C without autograft, because in the present study, nasal GCD was not lower but similar to postoperative temporal data of the same eye (p = 0.164; paired t test). CONCLUSIONS: Limbo-conjunctival autograft is a good technique for conjunctiva early recovery. When mitomycin C was added, the GCD reduction was lower than described using other surgical techniques. Mitomycin C, in optimal concentration and exposure, associated with LCA could be a good clinical option to minimize pterygium recurrence.

Healing indicators after pterygium excision by optical coherence tomography.

PURPOSE: To establish the sequence of tomographic changes in the tissue recovery process after pterygium excision and to propose healing indicators. METHODS: Optical coherence tomography (OCT) images were taken at 1 week, 1, 3 and 6 months after lesion excision in 73 eyes of 73 patients (33 male, 40 female; mean age 50, S.D. 5.0, range 40-70 years) with primary nasal pterygium. Biomicroscopy was performed at each visit and at 12 months, to diagnose clinical healing or lesion recurrence. The presence of well demarcated corneal epithelium, conjunctival epithelium, limbal demarcation area, and graft thickening were analysed. Comparisons between tomographic data of both clinical situations were made at each time point using contingency tables. RESULTS: Eleven eyes displayed lesion recurrence (R group) and 62 eyes showed no recurrence (NR group). Normal anatomical structures, corneal and conjunctival epithelium and limbal demarcation area, were identified by OCT images in a higher percentage of NR cases over time, compared to the R group where most of the cases presented without these markers of tissue recovery. In contrast, the variable graft thickening, which analysed a pathological event, revealed similar results in both groups (p > 0.05; Fisher's exact statistic), with a clear decrease of cases which showed graft thickening over time. Differences between groups started at 1 month, when no eye had yet presented clinical recurrence, with greater identification of corneal epithelium in the NR group (p = 0.04; Fisher's exact statistic). At 3 months, corneal and conjunctival epithelium identification tended to be more frequent in the NR than in the R group (in both cases, p = 0.0001; Fisher's exact statistic). Finally, at 6 months these different patterns consolidated, with a significantly higher number of limbal demarcation areas being identified in the NR group (p = 0.001; Fisher's exact statistic). In fact, this landmark of a normally structured limbus was never found in the R group. CONCLUSIONS: The sequence of tissue restoration, according to OCT images, seems to start in the cornea and end in the limbal area, similar to the process of pterygium injury in reverse. Although the visualisation of corneal epithelium could be an early indicator of successful surgery, identification of the limbal demarcation area, as a normal limbal pattern in OCT images, seems to be a better positive predictive value in diagnosing healing.

Threshold to predict astigmatism reduction after pterygium excision.

PURPOSE: To compare corneal astigmatism after pterygium excision, using limbal-conjunctival autograft (LCA) with and without mitomycin C (MMC) and to establish a threshold for postoperative astigmatism reduction. METHODS: Sixty-eight eyes with primary pterygium were consecutively sampled and assigned to LCA with MMC (MMC+) or LCA without MMC (MMC-). Corneal lesion length, corneal lesion area, preoperative corneal astigmatism (PRCA), and postoperative corneal astigmatism (POCA) at 1, 3, and 6 months were assessed. RESULTS: Thirty-six men and 24 women (60 eyes), aged between 24 and 65 years (mean ± SD, 41 ± 8.2 years), completed the study. Thirty-one eyes were included in the MMC+ group and 29 were in the MMC- group. Both groups showed astigmatism reduction (p < 0.05; paired, two-tailed t test) 1 month after the surgery and remained stable. No differences were found between groups in corneal lesion length, corneal lesion area, or astigmatism results at the four time points (p > 0.05, independent t test). Preoperative corneal astigmatism showed a significant correlation with POCA at 6 months (r = 0.529; p < 0.01). According to receiver operating characteristic curve analysis, the better threshold for astigmatism reduction with the surgery was 1.05 diopters of PRCA, with 82.5% sensitivity and 80.5% specificity. CONCLUSIONS: Both surgical procedures could have similar astigmatism results. Pterygium patients with more than 1.05 diopters of PRCA could reduce it after the surgery. Direct relationship between PRCA and POCA revealed that postoperative astigmatism reduction was partial. Therefore, for minimizing final astigmatism, preoperative values should be slightly above the threshold.

Ocular discomfort in pterygium patients.

PURPOSE: To evaluate the relationship between ocular discomfort and pterygium clinical characteristics. METHODS: The ocular comfort index test was self-completed by 25 men and 15 women (age [mean ± SD], 43 ± 11 years) with primary pterygium. Pterygium corneal area (PCA) and limbal perimeter, course and bilaterality of the lesion, visibility of episcleral vessels, conjunctival hyperemia, and exposure to dry or dusty environments were assessed. Spearman correlation and multiple linear regression were performed to evaluate the relationship between ocular discomfort and pterygium clinical characteristics. RESULTS: Ocular discomfort was inversely correlated with PCA (ρ = -0.447, p < 0.01) and directly correlated with the exposure to dry or dusty environments (ρ = 0.324, p < 0.05). The other studied factors did not show any significant relationship with discomfort symptoms. The linear regression analysis identified PCA as the only factor that significantly influenced ocular discomfort (R = -0.404, p < 0.01). CONCLUSIONS: The findings confirm an inverse linear relationship between ocular discomfort and PCA, providing evidence of corneal sensitivity loss in these patients.

Tear osmolarity and ocular changes in pterygium.

PURPOSE: To determine abnormalities in tear osmolarity (TO), tear function, and impression cytology in patients with pterygium and to assess the relationship between the variables. METHODS: Thirty eyes from 30 patients with primary nasal pterygium and 30 eyes from 30 volunteers without ocular pathologies or dry eye symptoms were enrolled in the present study. TO test, tear ferning test, fluorescein tear breakup time, Schirmer test, and impression cytology of the conjunctiva were performed. Analysis of variance was applied for intergroup comparisons, and Pearson correlation was used to calculate the strength of relationships between the variables. A statistical significance level of P<0.05 was considered. RESULTS: Pterygium patients had significantly higher TO, lower crystallization percentage, and lower goblet cell density (GCD) than control patients. A weak but significant negative correlation seems to exist between TO and crystallization percentage (r=-0.425, P<0.01) and between TO and GCD (r=-0.295, P<0.05). CONCLUSION: There is evidence to suggest that pterygium appears to induce unfavorable conditions of increasing TO that could trigger alterations in tear crystallization and GCD. Being aware of TO changes seems essential to understand the complex relationship among pterygium, tear film functions, and ocular surface changes.

Effects of tear hyperosmolarity on conjunctival cells in mild to moderate dry eye.

PURPOSE: To analyze the effects of tear hyperosmolarity on conjunctival cells in mild to moderate dry eye. METHODS: Sixty-eight subjects (35 females and 33 males, mean age 43, S.D. 20.3, range 18-87 years) with symptoms of dry eye were enrolled in the study. Patients with severe dry eye or any other condition that induces ocular inflammation were excluded. The sample was divided into two groups according to the tear osmolarity cut-off value of 308 mOsmol L(-1) measured in the right eye of each patient. Impression cytology of the temporal interpalpebral conjunctiva was performed and goblet cell density, nucleus diameter, cytoplasm diameter and nucleus/cytoplasm ratio of epithelial cells quantitatively assessed. A battery of tear tests (ferning test, tear break-up time and Schirmer I test) was also carried out in order to more completely describe the groups and understand the process. Analysis of variance (anova) was applied to establish cytological and tear differences between hyperosmolar and normal tear osmolarity eyes. Pearson's correlation was calculated between the cytological variables and tear osmolarity. RESULTS: The normal tear osmolarity group included patients with symptoms of dry eye, grade 1-2 of squamous metaplasia, and a number of positive tear signs of dry eye ranging between 0 and 3. The hyperosmolar tear group included patients with symptoms of dry eye, grade 1-2 of squamous metaplasia with significantly lower values of nucleus diameter (F(1,66) = 4.3, p = 0.040), and a number of positive tear signs of dry eye ranging between 1 (hyperosmolar tear) and 4. Mean reflex secretion of tears was clearly normal in both groups but significantly lower (F(1,66) = 7.2, p = 0.009) in the hyperosmolar tear group. Significant correlations were established for tear osmolarity and goblet cell density (r(33) = 0.45, p = 0.006) and nucleus/cytoplasm ratio (r(33) = -0.44, p = 0.009) in the normal tear osmolarity group but not in the hyperosmolar tear group. CONCLUSIONS: Mild to moderate hyperosmolar tear conditions seem to lead to an initial reduction of the conjunctival cell nucleus before the cytoplasm diameter showed a clear tendency to enlarge. The relationship between tear osmolarity and conjunctival cell characteristics seems to be linear only in the normal tear osmolarity group. These results also provide a plausible link between lower reflex secretion of tears and hyperosmolarity.

Effects of dietary L-arginine intake on cardiorespiratory and metabolic adaptation in athletes.

To assess the effect of diet enrichment with L-arginine or supplementation at high doses on physiological adaptation during exercise, 9 athletes followed 3 different diets, each over 3 consecutive days, with a wash-out period of 4 d between training sessions: control diet (CD), 5.5 +/- 0.3 g/d of L-arginine; Diet 1 (rich in L-arginine food), 9.0 +/- 1.1 g/d of L-arginine; and Diet 2 (the same as CD but including an oral supplement of 15 g/d), 20.5 +/- 0.3 g/d of L-arginine. Plasma nitrate levels of each participant were determined on the day after each treatment. Participants performed a submaximal treadmill test (initial speed 10-11 km/hr, work increments 1 km/hr every 4 min until 85-90% VO2max, and passive recovery periods of 2 min). Oxygen uptake and heart rate were monitored throughout the test. Blood lactate concentration ([La-]b) was determined at the end of each stage. Repeated-measures ANOVA and paired Student's t tests were used to compare the various physiological parameters between diets. The level of significance was set at p < .05. [La-]b showed a significant effect at the 5-min time point between CD and Diet 2 (CD 3.0 +/- 0.5 mM, Diet 2 2.5 +/- 0.5 mM, p = .03), but this tendency was not found at higher exercise intensities. No significant differences were observed in any of the cardiorespiratory or plasma nitrate levels. In conclusion, dietary L-arginine intake on the days preceding the test does not improve physiological parameters during exercise.

Supplementation with an antioxidant cocktail containing coenzyme Q prevents plasma oxidative damage induced by soccer.

The aim of the study was to determine the effects of an antioxidant supplementation, which includes coenzyme Q(10), on plasma and neutrophil oxidative stress and the antioxidant response after a soccer match. Nineteen voluntary male pre-professional footballers were randomly and double-blinded treated with either a multivitamin and mineral supplement (n = 8) or a placebo (n = 11). After the 3 months of supplementation, the sportsmen played a friendly soccer match of 60 min. The 3-month supplementation induced higher plasma ascorbate and coenzyme Q levels when compared to the placebo group. Antioxidant supplementation influenced plasma oxidative stress markers because they were lower in the supplemented group than in the placebo one after the match. The football match induced decreased neutrophil vitamin E levels and catalase and glutathione peroxidase activities but increased glutathione reductase activity. Antioxidant diet supplementation prevented plasma oxidative damage but did not influence the neutrophil response to a football match.