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Eye (London, England) Jun 2020Pterygia are common conjunctival degenerations with well-documented risk factors but an unclear pathogenesis. Better understanding of the pathogenesis of pterygium could... (Review)
Review
Pterygia are common conjunctival degenerations with well-documented risk factors but an unclear pathogenesis. Better understanding of the pathogenesis of pterygium could lead to improved surgical outcomes and decreased postoperative recurrence. Currently, pterygium excision with conjunctival autograft remains the preferred surgical technique to decrease pterygium recurrence. Many adjuvant therapies have been used in pterygium surgery to varying degrees of success. Topical cyclosporine, an immunosuppressive medication, in conjunction with conjunctival autograft was found to be most successful in decreasing pterygium recurrence according to a recent meta-analysis. Other adjuvant therapies such as mitomycin-C (MMC), 5-fluorouracil (5-FU), and beta-irradiation have also been used, though usage of these may cause multiple adverse effects. Recent research indicates that interactions between mouse double minute 2 (MDM2) and p53 could play a role in the occurrence of pterygium. Nutlin, an MDM2 antagonist, was found to have significantly less toxicity in conjunctival cells when compared with MMC on laboratory analysis of pterygium samples.
Topics: Animals; Conjunctiva; Follow-Up Studies; Mice; Mitomycin; Ophthalmologic Surgical Procedures; Pterygium; Recurrence; Transplantation, Autologous
PubMed: 32029918
DOI: 10.1038/s41433-020-0786-3 -
Indian Journal of Ophthalmology Mar 2022To evaluate and analyze the outcomes of sutureless and glue-free limbal-conjunctival autografting in cases of primary as well as recurrent pterygium.
PURPOSE
To evaluate and analyze the outcomes of sutureless and glue-free limbal-conjunctival autografting in cases of primary as well as recurrent pterygium.
METHODS
This prospective interventional study was carried out between February 2019 and February 2020 at a tertiary care hospital in North India. A.
UNLABELLED
total of 70 patients with pterygium underwent sutureless and glue-free limbal-conjunctival autograft. The patients were divided into two groups: group 1 patients with primary pterygium (n = 45), group 2 patients with recurrent pterygium (n = 25). The patients were followed up till 12 months postoperatively.
RESULTS
The mean age of the patients in group 1 and group 2 was 37.04 ± 8.69 years and 32.52 ± 6.49 years, respectively (P = 0.04). Postoperatively, no recurrence was recorded in group 1. Recurrence was noticed in two patients (8%) of group 2. The BCVA changed from 78.73 ± 9.86 letters to 80.15 ± 7.29 letters (P = 0.45) and from 79.6 ± 6.44 letters to 79.8 ± 5.86 letters (P = 0.45) in group 1 and group 2, respectively. Graft edema was found in seven (15.55%) cases of group 1 and four (16%) cases of group 2. Graft retraction was found in two (4.44%) cases of group 1 and three (12%) cases of group 2.
CONCLUSION
Sutureless and a glue-free limbal-conjunctival autograft is a safe and effective treatment option for primary as well as recurrent pterygium.
Topics: Adult; Autografts; Conjunctiva; Follow-Up Studies; Humans; Middle Aged; Pilot Projects; Postoperative Complications; Prospective Studies; Pterygium; Recurrence; Transplantation, Autologous; Treatment Outcome
PubMed: 35225514
DOI: 10.4103/ijo.IJO_1895_21 -
Ophthalmic Research 2022Pterygium is a kind of common conjunctival degeneration. The pathogenesis of pterygium is complex, and various biomarkers provide new targets for treatment and... (Review)
Review
Pterygium is a kind of common conjunctival degeneration. The pathogenesis of pterygium is complex, and various biomarkers provide new targets for treatment and prognosis. Currently, the most common treatment for pterygium is surgical excision, but it is invasive risk and has a high recurrence rate. Since the development of sequencing, gene chip technology, and proteomics technologies has been rapid, research on the internal mechanism of disease has been facilitated. This review focuses on recent advances in the discovery of biomarkers from the fields of genetics, proteomics, and epigenetics and their likely functional mechanisms and clinical applications in pterygium.
Topics: Biomarkers; Conjunctiva; Follow-Up Studies; Humans; Pterygium; Recurrence; Transplantation, Autologous
PubMed: 35405677
DOI: 10.1159/000523878 -
La Tunisie Medicale Jul 2023Pterygium surgery is a closed globe surface surgery. Although it is perfectly standard and followed by excellent results, it is not exempt from the general rule that...
INTRODUCTION
Pterygium surgery is a closed globe surface surgery. Although it is perfectly standard and followed by excellent results, it is not exempt from the general rule that there is no surgery without risk. It therefore seems important to integrate simulation as a pedagogical tool for training ophthalmology residents in pterygium surgery.
AIM
To evaluate the effectiveness of procedural simulation as a training tool for pterygium surgery.
RESULTS
During the study period, eight residents participated in the three workshops. The global assessment of residents' knowledge showed a mean score of 3/5 [1.5/5-4/5] and 4.1/5 [3.25/5-5/5] before and after the training respectively. There was a significant negative correlation between the initial score on the pre-test and the improvement of this score on the post-test, with an r'=-0.87 and a p=0.005. We noted a significant improvement in the global performance score (p<0.001) and even a significant improvement in the specific performance score (p=0.02) between the 3 workshops. The average training satisfaction score was 13.87/16 [10/16-16/16]. We noted a significant positive correlation with r=0.838 and p=0.009 between knowledge improvement and learner satisfaction.
CONCLUSION
The training of fundus examination using an ophthalmoscopic simulator can improve the skills and knowledge of ophthalmic learners. This type of training can be an innovative addition to traditional learning methods.
Topics: Humans; Pterygium; Fundus Oculi; Knowledge; Ophthalmology; Ophthalmoscopy
PubMed: 38445419
DOI: No ID Found -
Cells Jun 2021Pterygium is a multifaceted pathology that displays apparent conflicting characteristics: benign (e.g., self-limiting and superficial), bad (e.g., proliferative and... (Review)
Review
Pterygium is a multifaceted pathology that displays apparent conflicting characteristics: benign (e.g., self-limiting and superficial), bad (e.g., proliferative and potentially recurrent) and ugly (e.g., signs of preneoplastic transformation). The natural successive question is: why are we lacking reports showing that pterygium lesions become life-threatening through metastasis, especially since pterygium has considerable similarities with UV-related malignancies on the molecular level? In this review, we consider how our pathophysiological understanding of the benign pterygium pathology overlaps with ocular surface squamous neoplasia and skin cancer. The three UV-related disorders share the same initial insult (i.e., UV radiation) and responsive repair mechanisms to the ensuing (in)direct DNA damage. Their downstream apoptotic regulators and other cellular adaptations are remarkably alike. However, a complicating factor in understanding the fine line between the self-limiting nature of pterygium and the malignant transformation in other UV-related diseases is the prominent ambiguity in the pathological evaluation of pterygium biopsies. Features of preneoplastic transformation (i.e., dysplasia) are used to define normal cellular reactions (i.e., atypia and metaplasia) and vice versa. A uniform grading system could help in unraveling the true nature of this ancient disease and potentially help in identifying the earliest intervention point possible regarding the cellular switch that drives a cell's fate towards cancer.
Topics: Animals; Apoptosis; DNA Damage; Humans; Neoplasms, Squamous Cell; Pterygium; Risk Factors; Ultraviolet Rays
PubMed: 34206333
DOI: 10.3390/cells10071567 -
Archives of Pathology & Laboratory... Jun 2018- Human papillomavirus (HPV) has a well-known role in the pathogenesis of squamous cell carcinoma and precursor lesions of the cervix, anogenital region, and head and... (Review)
Review
CONTEXT
- Human papillomavirus (HPV) has a well-known role in the pathogenesis of squamous cell carcinoma and precursor lesions of the cervix, anogenital region, and head and neck, but its role in the development of squamous neoplasms of the eye, particularly the conjunctiva, remains unclear.
OBJECTIVE
- To review recent evidence implicating HPV in the pathophysiology of ocular lesions.
DATA SOURCES
- Published articles obtained from a PubMed search of the English literature were the primary sources for this review.
CONCLUSIONS
- The low-risk HPV types 6 and 11 appear to play a role in the development of at least a subset of conjunctival squamous papillomas. The role of HPV in the pathogenesis of pterygium and ocular surface squamous neoplasia is less well defined. There is evidence to suggest that HPV may be a cofactor in the development of these lesions, acting in concert with ultraviolet radiation and/or human immunodeficiency virus infection in a subgroup of cases.
Topics: Carcinoma, Squamous Cell; Conjunctival Neoplasms; Eye Neoplasms; Human papillomavirus 11; Human papillomavirus 16; Humans; Papilloma; Papillomaviridae; Papillomavirus Infections; Pterygium; Ultraviolet Rays
PubMed: 29848037
DOI: 10.5858/arpa.2017-0571-RA -
Arquivos Brasileiros de Oftalmologia 2020The aim of the present study was to measure the free carnitine and acylcarnitine levels in pterygium tissue and normal conjunctival tissue at the metabolomics level...
PURPOSE
The aim of the present study was to measure the free carnitine and acylcarnitine levels in pterygium tissue and normal conjunctival tissue at the metabolomics level using tandem mass spectrometry.
METHODS
In this prospective, clinical randomized study, pterygium tissues and normal conjunctival tissues taken during pterygium excision with autograft were compared regarding their free carnitine and acylcarnitine profiles. After tissue homogenization, carnitine levels were measured using tandem mass spectrometry. The data were statistically analyzed with the Wilcoxon signed-rank test.
RESULTS
Pterygium and normal conjunctival tissue samples from a single eye of 29 patients (16 females, 13 males; mean age, 54.75 ± 11.25 years [range, 21-78 years]) were evaluated. While the free carnitine (C0) level was significantly high in the pterygium tissue (p<0.001), acylcarnitine levels were significantly high in some esterized derivatives (C2, C5, C5:1, C5DC, C16:1, C18, methylglutarylcarnitine) (p<0.05). No statistically significant difference was determined for the other esterized derivatives (p>0.05).
CONCLUSION
That the carnitine levels in pterygium tissue were higher suggests that acceleration of cell metabolism developed secondary to chronic inflammation and the premalignant characteristics of pterygium tissue. High carnitine levels may also effectively suppress the apoptosis process. The data reported in our study indicate that further, more extensive studies of the carnitine profile could help clarify the pathogenesis of pterygium.
Topics: Adult; Aged; Carnitine; Conjunctiva; Female; Humans; Male; Metabolomics; Middle Aged; Prospective Studies; Pterygium; Tandem Mass Spectrometry; Young Adult
PubMed: 31531547
DOI: 10.5935/0004-2749.20200001 -
Arquivos Brasileiros de Oftalmologia 2019Pterygium pathogenesis has been mainly asso ciated with UV light exposure; however, this association remains quite controversial. The complete mechanism of pterygium... (Review)
Review
Pterygium pathogenesis has been mainly asso ciated with UV light exposure; however, this association remains quite controversial. The complete mechanism of pterygium also remains to be clarified. Factors such as inflammation, viral infection, oxidative stress, DNA methylation, inflammatory mediators, extracellular matrix modulators, apoptotic and oncogenic proteins, loss of heterozygosity, microsatellite instability, lymphangiogenesis, epithelial-mesenchymal cell transition, and alterations in cholesterol metabolism have been identified as causes. Several studies aimed to clarify the molecular mechanisms underlying the growth and proliferation of pterygium. Understanding its molecular basis provides new potential therapeutic targets for its prevention and treatment. A comprehensive search of the databases, namely, MedLine, EMBASE, and LILACS, was conducted with the following key words: pterygium, epidemiology, pathogenesis, biomarkers, and review. This review describes the epidemiology, clinical presentation, and current investigation of biological mediators involved in pterygium development.
Topics: Apoptosis Regulatory Proteins; Extracellular Matrix; Female; Gene Expression; Genes, Tumor Suppressor; Genetic Markers; Humans; Male; Pterygium
PubMed: 31576927
DOI: 10.5935/0004-2749.20190103 -
BioMed Research International 2019MiRNAs have been widely analyzed in the occurrence and development of many diseases, including pterygium. This study aimed to identify the key genes and miRNAs in...
PURPOSE
MiRNAs have been widely analyzed in the occurrence and development of many diseases, including pterygium. This study aimed to identify the key genes and miRNAs in pterygium and to explore the underlying molecular mechanisms.
METHODS
MiRNA expression was initially extracted and pooled by published literature. Microarray data about differentially expressed genes was downloaded from Gene Expression Omnibus (GEO) database and analyzed with the R programming language. Functional and pathway enrichment analyses were performed using the database for Annotation, Visualization and Integrated Discovery (DAVID). The protein-protein interaction network was constructed with the STRING database. The associations between chemicals, differentially expressed miRNAs, and differentially expressed genes were predicted using the online resource. All the networks were constructed using Cytoscape.
RESULTS
We found that 35 miRNAs and 301 genes were significantly differentially expressed. Functional enrichment analysis showed that upregulated genes were significantly enriched in extracellular matrix (ECM) organization, while downregulated genes were mainly involved in cell death and apoptotic process. Finally, we concluded the chemical-gene affected network, miRNA-mRNA interacted networks, and significant pathway network.
CONCLUSION
We identified lists of differentially expressed miRNAs and genes and their possible interaction in pterygium. The networks indicated that ECM breakdown and EMT might be two major pathophysiological mechanisms and showed the potential significance of PI3K-Akt signalling pathway. MiR-29b-3p and collagen family (COL4A1 and COL3A1) might be new treatment target in pterygium.
Topics: Databases, Nucleic Acid; Gene Expression Regulation; Gene Regulatory Networks; Humans; MicroRNAs; Models, Biological; Oligonucleotide Array Sequence Analysis; Programming Languages; Protein Interaction Maps; Pterygium
PubMed: 31341891
DOI: 10.1155/2019/2767512 -
Scientific Reports Jan 2022Pterygium is a common ocular surface condition frequently associated with irritative symptoms. The precise identity of its critical triggers as well as the hierarchical... (Meta-Analysis)
Meta-Analysis
Pterygium is a common ocular surface condition frequently associated with irritative symptoms. The precise identity of its critical triggers as well as the hierarchical relationship between all the elements involved in the pathogenesis of this disease are not yet elucidated. Meta-analysis of gene expression studies represents a novel strategy capable of identifying key pathogenic mediators and therapeutic targets in complex diseases. Samples from nine patients were collected during surgery after photo documentation and clinical characterization of pterygia. Gene expression experiments were performed using Human Clariom D Assay gene chip. Differential gene expression analysis between active and atrophic pterygia was performed using limma package after adjusting variables by age. In addition, a meta-analysis was performed including recent gene expression studies available at the Gene Expression Omnibus public repository. Two databases including samples from adults with pterygium and controls fulfilled our inclusion criteria. Meta-analysis was performed using the Rank Production algorithm of the RankProd package. Gene set analysis was performed using ClueGO and the transcription factor regulatory network prediction was performed using appropriate bioinformatics tools. Finally, miRNA-mRNA regulatory network was reconstructed using up-regulated genes identified in the gene set analysis from the meta-analysis and their interacting miRNAs from the Brazilian cohort expression data. The meta-analysis identified 154 up-regulated and 58 down-regulated genes. A gene set analysis with the top up-regulated genes evidenced an overrepresentation of pathways associated with remodeling of extracellular matrix. Other pathways represented in the network included formation of cornified envelopes and unsaturated fatty acid metabolic processes. The miRNA-mRNA target prediction network, also reconstructed based on the set of up-regulated genes presented in the gene ontology and biological pathways network, showed that 17 target genes were negatively correlated with their interacting miRNAs from the Brazilian cohort expression data. Once again, the main identified cluster involved extracellular matrix remodeling mechanisms, while the second cluster involved formation of cornified envelope, establishment of skin barrier and unsaturated fatty acid metabolic process. Differential expression comparing active pterygium with atrophic pterygium using data generated from the Brazilian cohort identified differentially expressed genes between the two forms of presentation of this condition. Our results reveal differentially expressed genes not only in pterygium, but also in active pterygium when compared to the atrophic ones. New insights in relation to pterygium's pathophysiology are suggested.
Topics: Adult; Aged; Databases, Genetic; Female; Gene Expression Profiling; Gene Expression Regulation; Gene Regulatory Networks; Humans; Male; MicroRNAs; Middle Aged; Oligonucleotide Array Sequence Analysis; Pterygium; RNA, Messenger; Transcriptome
PubMed: 34997134
DOI: 10.1038/s41598-021-04248-x