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Alternative Therapies in Health and... Nov 2023Pterygium and conjunctival laxity are common ocular conditions that can significantly affect visual comfort and quality of life. Therefore, it is essential to...
The Effect of Conjunctival Flap Transplantation, Pterygium Excision, and Scleral Fixation Surgery in Treating Pterygium Combined with Conjunctival Laxity and Its Impact on Postoperative Complications.
OBJECTIVE
Pterygium and conjunctival laxity are common ocular conditions that can significantly affect visual comfort and quality of life. Therefore, it is essential to investigate ways to treat these problems. This study aimed to compare the effectiveness of same-stage trapezoidal conjunctival flap transplantation, pterygium excision, and scleral fixation surgery versus staged pterygium excision, crescentic conjunctiva excision, and scleral fixation surgery in treating pterygium combined with conjunctival laxity. The study also aimed to evaluate the impact of these surgical techniques on postoperative complications.
METHODS
From June 2019 to May 2021, 90 patients (90 eyes) with pterygium combined with conjunctival laxity were included in this study and were randomly divided into two groups (A and B) using a simple number table method. Group A underwent same-stage trapezoidal conjunctival flap transplantation, pterygium excision, and scleral fixation surgery, while group B underwent staged pterygium excision, crescentic conjunctiva excision, and scleral fixation surgery. The International Ocular Surface Disease Index (OSDI), degree of conjunctival laxity excision, changes in ocular tear film dynamics, recurrence rate, and postoperative complications were compared between the two groups.
RESULTS
The results showed that different surgical methods for pterygium and conjunctivochalasis did not significantly improve the symptoms and quality of life of patients. This suggests that more intensive research is needed to find more effective treatments. Therefore, the risks and benefits should be carefully considered when selecting ophthalmologic surgery, OSDI scores and fluorescein staining results of both groups were trending downward after surgery, while the breakup time of the tear film and height of the tear meniscus was increasing but there was no significant difference in the above indicators (P > .05). However, there was no significant difference in the above indicators between the two groups before surgery, at 1, 3, and 6 months, and at 1 year after surgery (P > .05). There was also no significant difference in the degree of conjunctival laxity excision between the two groups at 1 and 3 months after surgery (P > .05). Finally, there was no significant difference in the healing time of the conjunctiva and recurrence rates between the two groups (P > .05). The results showed that different surgical methods for pterygium and conjunctivochalasis did not significantly improve the symptoms and quality of life of patients. This suggests that more intensive research is needed to find more effective treatments. Therefore, the risks and benefits should be carefully considered when selecting ophthalmologic surgery.
CONCLUSION
The results of this study showed no significant differences between surgical techniques, making monitoring and management of complications after surgery even more critical. Patients need to be carefully watched for possible complications such as infection, discomfort, and inflammation. Doctors and medical teams should be alert in advance and take appropriate measures to deal with these problems in a timely manner to ensure the success of the operation and the comfort of the patient. By monitoring and proactively managing potential complications, unnecessary pain and complexity can be reduced, thereby improving patient experience and outcomes. Additionally, the study had several limitations, including a small sample size, a limited study period, and failure to consider other potential factors. These limitations need to be addressed in future studies to validate and extend the results of this study. In conclusion, same-stage trapezoidal conjunctival flap transplantation, pterygium excision, and scleral fixation surgery is an effective treatment for patients with pterygium combined with conjunctival laxity, which can improve their visual function and ocular tear film dynamics. However, careful monitoring and management of postoperative complications are necessary.
PubMed: 37944957
DOI: No ID Found -
Journal of Surgical Case Reports Oct 2023Characteristic features of popliteal pterygium syndrome (PPS) associated with the craniofacial region include cleft palate, syngnathia, and difficulty with...
Characteristic features of popliteal pterygium syndrome (PPS) associated with the craniofacial region include cleft palate, syngnathia, and difficulty with reconstruction. We developed a new procedure of submucosal dissection with periosteotomy to close the folded mucosa in bilateral cleft lip and palate patients with PPS. This technique could be applicable for patients with wide cleft palate.
PubMed: 37873051
DOI: 10.1093/jscr/rjad575 -
Advances in Ophthalmology Practice and... 2023Genetic information is stored in the bases of double-stranded DNA. However, the integrity of DNA molecules is constantly threatened by various mutagenic agents,... (Review)
Review
BACKGROUND
Genetic information is stored in the bases of double-stranded DNA. However, the integrity of DNA molecules is constantly threatened by various mutagenic agents, including pollutants, ultraviolet light (UV), and medications. To counteract these environmental damages, cells have established multiple mechanisms, such as producing molecules to identify and eliminate damaged DNA, as well as reconstruct the original DNA structures. Failure or insufficiency of these mechanisms can cause genetic instability. However, the role of genome stability in eye diseases is still under-researched, despite extensive study in cancer biology.
MAIN TEXT
As the eye is directly exposed to the external environment, the genetic materials of ocular cells are constantly under threat. Some of the proteins essential for DNA damage repair, such as pRb, p53, and RAD21, are also key during the ocular disease development. In this review, we discuss five ocular diseases that are associated with genomic instability. Retinoblastoma and pterygium are linked to abnormal cell cycles. Fuchs' corneal endothelial dystrophy and age-related macular degeneration are related to the accumulation of DNA damage caused by oxidative damage and UV. The mutation of the subunit of the cohesin complex during eye development is linked to sclerocornea.
CONCLUSIONS
Failure of DNA damage detection or repair leads to increased genomic instability. Deciphering the role of genomic instability in ocular diseases can lead to the development of new treatments and strategies, such as protecting vulnerable cells from risk factors or intensifying damage to unwanted cells.
PubMed: 37846358
DOI: 10.1016/j.aopr.2023.03.002 -
Journal of Clinical Medicine Sep 2023Amniotic membrane (AM) has anti-inflammation, anti-fibrotic, and regenerative effects. Sutureless cryopreserved AM transplantation, ProKera (Bio-Tissue, Inc., Miami, FL,...
Amniotic membrane (AM) has anti-inflammation, anti-fibrotic, and regenerative effects. Sutureless cryopreserved AM transplantation, ProKera (Bio-Tissue, Inc., Miami, FL, USA), is easily applied by ophthalmologists in the treatment of ocular surface diseases. This retrospective study included patients with ocular surface diseases who received ProKera between January 2022 and May 2023. Six patients (9 eyes) with a mean age of 56.8 ± 20.8 years old (range 25-74) and a mean follow-up period of 7.8 ± 4.1 months (range 1-12) were included, including 2 of recurrent conjunctival tumors with limbal and corneal involvement (cases 1-2), 1 of pterygium with marked astigmatism (case 3) and 3 of Stevens-Johnson syndrome (SJS, cases 4-6). ProKera was inserted after the lesion excision and deep keratectomy in cases 1-3, and no recurrence or corneal complication was noted. Cases 4-5 were discharged from the intensive care unit and presented with severe chronic SJS. Most ocular manifestations improved significantly after symblepharon release and ProKera insertion, except for corneal conjunctivalization in 1 eye (case 5). Case 6 involved early ProKera use at the bedside during acute SJS, resulting in complete resolution. We concluded that the adjunctive application of ProKera can be effective for ocular surface reconstruction and provides options to intervene earlier for outpatients or patients unstable for invasive surgical intervention.
PubMed: 37834866
DOI: 10.3390/jcm12196222 -
Clinical Ophthalmology (Auckland, N.Z.) 2023We measure changes in ocular surface sensation after pterygium surgery with a conjunctival autograft.
PURPOSE
We measure changes in ocular surface sensation after pterygium surgery with a conjunctival autograft.
METHODS
This prospective, interventional study was carried out in patients, with nasal primary pterygium undergoing pterygium surgery with conjunctival autograft. Sensation was measured by applying the tip of the Cochet-Bonnet esthesiometer filament perpendicular to the ocular surface in the cornea and conjunctiva. Patients were tested preoperatively (baseline), and at 2 weeks, 2 and 4 months, postoperatively.
RESULTS
Nineteen eyes of 18 patients completed the 4-month follow-up. Mean age was 61±10.1 (range 36-76) years. Corneal sensation returned to normal values in all at 2 and at 4 months. The central cornea was significantly more sensitive compared to the average of the four peripheral measurements pre- (59.2 mm vs 48.3 mm, p=0.000) and postoperatively (59.2 mm vs 48.4 mm, p=0.000). Conjunctival sensation was reduced significantly 2 months postoperatively in the inferior region (p=0.04). Four months postoperatively, it was more sensitive in the superior area (13.9 mm vs 17.1 mm, p=0.01) and the inferior area (13.7 mm vs 19.5 mm, p=0.003). In each matching area, the cornea was significantly more sensitive than the conjunctiva pre- and postoperatively (p=0.00). Sensation was not significantly different between the sexes or age groups.
CONCLUSION
This study demonstrates the presence of inferior and superior conjunctival hyperesthesia at conjunctival autograft sites after pterygium surgery. The healing process, sensory input, tear film instability and epitheliopathy of the ocular surface are possible explanations for these novel findings.
PubMed: 37818286
DOI: 10.2147/OPTH.S426799 -
Pharmacological Research Nov 2023Ocular neovascular disease (OND), characterized by the aberrant formation of immature blood vessels, is the leading cause of vision impairment and blindness. It is... (Review)
Review
Ocular neovascular disease (OND), characterized by the aberrant formation of immature blood vessels, is the leading cause of vision impairment and blindness. It is important to find effective ways to diagnose and treat these diseases. Circular RNA (circRNA) is a group of endogenous non-coding RNA that play a crucial role in regulating different biological processes. Due to their close association with ocular disease and angiogenesis, circRNAs have become a hotspot in OND research. In this review, we intensively investigate the possibility of using circRNAs in the management of ONDs. In general, angiogenesis is divided into five phases. On the basis of these five steps, we describe the potential of using circRNAs by introducing how they regulate angiogenesis. Subsequently, the interactions between circRNAs and ONDs, including pterygium, corneal neovascularization, age-related macular degeneration, diabetic retinopathy, and retinopathy of prematurity, are analyzed in detail. We also introduce the potential use of circRNAs as OND diagnostic biomarkers. Finally, we summarize the prospects of using circRNAs as a potential strategy in OND management. The gaps in recent research are also pointed out with the purpose of promoting the introduction of circRNAs into clinical applications.
Topics: Humans; Infant, Newborn; RNA, Circular; Eye; Retinal Diseases; Macular Degeneration; Diabetic Retinopathy
PubMed: 37797661
DOI: 10.1016/j.phrs.2023.106946 -
Frontiers in Pediatrics 2023Spondylocostal dysostosis is a rare genetic disorder caused by mutations in , , , , , and . A particular form of this disorder characterized by the association of...
BACKGROUND
Spondylocostal dysostosis is a rare genetic disorder caused by mutations in , , , , , and . A particular form of this disorder characterized by the association of spondylocostal dysostosis with multiple pterygia has been reported and called spondylospinal thoracic dysostosis. Both disorders affect the spine and ribs, leading to abnormal development of the spine. Spondylospinal thoracic dysostosis is a rare syndrome characterized by the association of multiple vertebral segmentation defects, thoracic cage deformity, and multiple pterygia. This syndrome can be considered a different form of the described spondylocostal dysostosis. However, no genetic testing has been conducted for this rare disorder so far.
METHODS
We report here the case of an 18-month-old female patient presenting the clinical and radiological features of spondylospinal thoracic dysostosis. To determine the underlying genetic etiology, whole exome sequencing (WES) and Sanger sequencing were performed.
RESULTS
Using WES, we identified a variant in the gene c. 628C>T, already reported in the non-lethal form of multiple pterygium syndrome. In addition, following the analysis of WES data, using bioinformatic tools, for oligogenic diseases, we identified candidate modifier genes, and , that could impact the clinical manifestations.
CONCLUSION
We showed a potential association between and the uncommon spondylocostal dysostosis phenotype that would require further validation on larger cohort.
PubMed: 37744435
DOI: 10.3389/fped.2023.1132023 -
The British Journal of Ophthalmology Nov 2023The purpose of this double-masked, parallel randomised controlled trial was to compare the recurrence rate and other outcomes between conjunctival-limbal autograft... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
The purpose of this double-masked, parallel randomised controlled trial was to compare the recurrence rate and other outcomes between conjunctival-limbal autograft (CLAu) and mini-simple limbal epithelial transplantation (mini-SLET) after excision of pterygium.
METHODS
Eligibility criteria for participants was the presence of a primary nasal pterygium extending equally to or greater than two millimetres on the cornea on its horizontal axis from the nasal limbus. The participants were allocated into two groups (CLAu and mini-SLET) using simple randomisation with a table of random numbers. Participants and the outcome assessor were masked to the intervention. The study protocol is listed and available on https://clinicaltrials.gov (Identifier: NCT03363282).
RESULTS
A total of 61 eyes were enrolled in the study, 33 underwent CLAu (group 1) and 28 mini-SLET (group 2), all eyes were analysed in each group. At 2, 3, 6 and 12 months the CLAu group exhibited a recurrence of 0%, 6.1%, 8.1% and 8.1%, while the mini-SLET exhibited a recurrence of 0%, 17.9%, 50% and 53.5% (p<0.05). There were no intraoperative or postoperative complications in either of the two groups.
CONCLUSION
The findings of this study suggest that mini-SLET has a higher recurrence rate and provides no advantage over CLAu in the treatment of primary pterygium.
Topics: Humans; Pterygium; Autografts; Conjunctiva; Transplantation, Autologous; Limbus Corneae; Recurrence; Treatment Outcome; Follow-Up Studies
PubMed: 37739769
DOI: 10.1136/bjo-2021-320707 -
International Journal of Ophthalmology 2023Pterygium is a prevalent ocular disease that can cause discomfort and vision impairment. Early and accurate diagnosis is essential for effective management. Recently,...
Pterygium is a prevalent ocular disease that can cause discomfort and vision impairment. Early and accurate diagnosis is essential for effective management. Recently, artificial intelligence (AI) has shown promising potential in assisting clinicians with pterygium diagnosis. This paper provides an overview of AI-assisted pterygium diagnosis, including the AI techniques used such as machine learning, deep learning, and computer vision. Furthermore, recent studies that have evaluated the diagnostic performance of AI-based systems for pterygium detection, classification and segmentation were summarized. The advantages and limitations of AI-assisted pterygium diagnosis and discuss potential future developments in this field were also analyzed. The review aims to provide insights into the current state-of-the-art of AI and its potential applications in pterygium diagnosis, which may facilitate the development of more efficient and accurate diagnostic tools for this common ocular disease.
PubMed: 37724272
DOI: 10.18240/ijo.2023.09.04 -
International Ophthalmology Dec 2023Hypoxia-inducible factors (HIFs) are considered to play a significant role in the pathogenesis of pterygium. The aim of this study was to investigate the relative...
PURPOSE
Hypoxia-inducible factors (HIFs) are considered to play a significant role in the pathogenesis of pterygium. The aim of this study was to investigate the relative expression or immunoreactivity of HIF1α and HIF2α in the epithelium of primary pterygium, recurrences and healthy conjunctiva.
METHODS
Immunohistochemical staining was performed with antibodies against HIF1α and HIF2α, respectively, on 55/84 primary pterygium specimens, 6/28 recurrences and 20/20 control tissues (healthy conjunctiva).
RESULTS
Immunohistochemical staining revealed lower epithelial immunoreactivity of HIF1α and HIF2α in both primary pterygium (11% and 38%) and recurrences (18% and 21%) when compared to healthy conjunctival tissue (46% and 66%). Differences between immunoreactivity of HIF1α and of HIF2α in primary pterygium and controls were each highly significant (p < .001). Within the group of primary pterygium, epithelial immunoreactivity of HIF2α (38%) was significantly higher than that of HIF1α (11%). In recurrent pterygium and healthy conjunctiva, immunoreactivity levels of HIF2α were higher than those of HIF1α as well; however, differences between both isoforms were not significant.
CONCLUSION
Our study shows evidence that the higher expressed epithelial HIF2α, rather than HIF1α, and the balance between both HIF isoforms might be relevant factors associated with pathogenesis of primary pterygium. Modulation of HIF2α levels and activity may thus offer a new therapeutic approach to the treatment of advancing pterygium where the initial stage with its HIF1-peak has already passed.
Topics: Humans; Pterygium; Epithelium; Conjunctiva; Protein Isoforms
PubMed: 37684398
DOI: 10.1007/s10792-023-02855-3