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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 -
Cornea Feb 2021This systematic review examines the specific effects of pingueculum and pterygium on the ocular surface and evaluates the efficacy of surgical excision in reversing... (Meta-Analysis)
Meta-Analysis
PURPOSE
This systematic review examines the specific effects of pingueculum and pterygium on the ocular surface and evaluates the efficacy of surgical excision in reversing those effects.
METHODS
A systematic review was performed according to the Preferred Reporting Items for the Systematic Review and Meta-Analyses statement and included 59 articles studying the effects of pterygium and pingueculum on the ocular surface as measured by tear break-up time (TBUT), Schirmer testing, tear osmolarity, Ocular Surface Disease Index (OSDI), and the effects of surgical removal on these ocular surface parameters.
RESULTS
In most studies, eyes with pterygium or pingueculum when compared with control eyes had a statistically significantly lower TBUT (average 3.72 s), lower Schirmer I without anesthesia (average 3.01 mm), lower Schirmer II (average 4.10 mm), higher tear osmolarity (average 12.33 mOsm/L), and higher OSDI (average 6.82 points). Moreover, excision of pterygium and pingueculum led to a statistically significantly higher TBUT (average 3.15 s higher at 1 mo postexcision), lower tear osmolarity (average 3.10 mOsm/L lower at 3 mo postexcision), and lower OSDI score (average 2.86 points lower 1 mo postexcision) in most of the studies. The effect of excision on Schirmer test scores was equivocal because most studies did not reach significance.
CONCLUSIONS
Our data confirm the relationship between pterygium and pingueculum and abnormal tear function and symptoms of dry eye disease. Furthermore, the data suggest that tear film parameters might improve after surgical removal of pterygium or pingueculum. Future studies would be helpful in exploring the potential role of pterygium and pingueculum excision in the management of dry eye disease.
Topics: Conjunctival Diseases; Cornea; Dry Eye Syndromes; Humans; Ophthalmologic Surgical Procedures; Pterygium; Tears; Treatment Outcome
PubMed: 33156079
DOI: 10.1097/ICO.0000000000002575 -
The Israel Medical Association Journal... Mar 2023The cornea is one of the most densely innervated in the body. Pterygium surgery includes removal of the pterygium tissue from the cornea and conjunctiva followed by...
BACKGROUND
The cornea is one of the most densely innervated in the body. Pterygium surgery includes removal of the pterygium tissue from the cornea and conjunctiva followed by autologous conjunctival grafting.
OBJECTIVES
To examine the change in corneal and conjunctival sensation post-pterygium surgery.
METHODS
This prospective study included patients with primary pterygium. We collected and analyzed demographic data, visual acuity (VA), refraction, quantified sensation, and corneal tomography. Comparison in sensation in the cornea, conjunctiva, and conjunctival autograft was recorded the day of surgery and at least 6 months postoperatively.
RESULTS
Nine patients participated in the study. Mean follow-up time was 9 months (9 3.3, 6-12.4). No complications were documented during or following surgery and no recurrences were found. Statistically significant increases in corneal sensation in the nasal corneal and in the nasal conjunctival areas were noted by the end of follow-up compared to before surgery (P = 0.05, paired samples t-test). There was a significant correlation between the increase in nasal corneal and conjunctival sensation with improved Schirmer testing outcomes and tear break-up time after surgery (P = 0.05, P = 0.01, Pearson correlation). There was a positive correlation between the changes in nasal corneal sensation after surgery and improved changes in VA (P = 0.02, Pearson correlation).
CONCLUSIONS
We found improvement in sensation 9 months after pterygium surgery, which may be due to reinnervation of the cornea and conjunctival autograft from the neighboring non-injured nerve fibers. Larger studies with confocal microscopy should be conducted for further analysis.
Topics: Humans; Pterygium; Prospective Studies; Conjunctiva; Cornea; Transplantation, Autologous; Sensation; Follow-Up Studies
PubMed: 36946664
DOI: No ID Found -
The British Journal of Ophthalmology Jun 2006Can we provide medical and not surgical cure?
Can we provide medical and not surgical cure?
Topics: Humans; Insulin-Like Growth Factor Binding Protein 3; Pterygium; Ultraviolet Rays
PubMed: 16714259
DOI: 10.1136/bjo.2006.091413 -
Indian Journal of Ophthalmology Sep 2021This study aimed to evaluate the surgical outcomes of pterygial excision for primary and recurrent pterygia by a single method of pterygia excision combined with two...
PURPOSE
This study aimed to evaluate the surgical outcomes of pterygial excision for primary and recurrent pterygia by a single method of pterygia excision combined with two conjunctival flaps.
METHODS
This retrospective study divided 193 cases of pterygium into the primary (140 cases) and recurrent (53 cases) pterygium groups. Following double-sliding conjunctival transposition flap operation and surgical excision of the pterygium, the success and recurrence rates of pterygial surgery were assessed based on visual acuity and corneal and total astigmatism during follow-up at least 6 months.
RESULTS
Both primary and recurrent pterygium groups showed significant improvements in visual acuity and astigmatism (corneal and total) between before and after this procedure. Total astigmatism and success rate of primary pterygium were significantly better than those for recurrent pterygium. Two cases (1.4%) of primary pterygium and four cases (7.5%) of recurrent pterygium developed recurrence, corresponding to a rate of 3.1% (6/193 cases). The success rates significantly make a difference between primary and recurrent groups but did not differ significantly between the first recurrent and over twice recurrent pterygium. However, visual acuity, cornea, and total astigmatism improved significantly after surgery in first recurrent group but not in over twice recurrent group.
CONCLUSION
The double-sliding conjunctival flaps surgery appeared to be a useful method, with a better success rate and lower pterygial recurrence in pterygium surgery. Especially, when pterygium is larger or recurrent type, this technique can be easily covered the bare sclera, as compared to any transposition conjunctival flap operation.
Topics: Conjunctiva; Humans; Ophthalmologic Surgical Procedures; Pterygium; Retrospective Studies; Treatment Outcome
PubMed: 34427232
DOI: 10.4103/ijo.IJO_2982_20 -
International Journal of Molecular... Jan 2023Pterygium and primary Sjögren's Syndrome (pSS) share many similarities in clinical symptoms and ocular pathophysiological changes, but their etiology is unclear. To...
Pterygium and primary Sjögren's Syndrome (pSS) share many similarities in clinical symptoms and ocular pathophysiological changes, but their etiology is unclear. To identify the potential genes and pathways related to immunity, two published datasets, GSE2513 containing pterygium information and GSE176510 containing pSS information, were selected from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) of pterygium or pSS patients compared with healthy control conjunctiva, and the common DEGs between them were analyzed. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were conducted for common DEGs. The protein-protein interaction (PPI) network was constructed using the STRING database to find the hub genes, which were verified in clinical samples. There were 14 co-upregulated DEGs. The GO and KEGG analyses showed that these common DEGs were enriched in pathways correlated with virus infection, antigen processing and presentation, nuclear factor-kappa B (NF-κB) and Th17 cell differentiation. The hub genes (, , , , and ) were selected by PPI construction. In the era of the COVID-19 epidemic, the relationship between virus infection, vaccination, and the incidence of pSS and pterygium growth deserves more attention.
Topics: Humans; Gene Expression Profiling; Pterygium; Sjogren's Syndrome; COVID-19; Conjunctiva; Computational Biology; Gene Regulatory Networks
PubMed: 36768371
DOI: 10.3390/ijms24032047 -
Romanian Journal of Ophthalmology 2021To evaluate the effect of pterygium excision on intraocular lens (IOL) power and refraction. The present study was carried out on patients with combined cataract and...
To evaluate the effect of pterygium excision on intraocular lens (IOL) power and refraction. The present study was carried out on patients with combined cataract and pterygium excision (combined group) and pterygium surgery first and cataract surgery after one month (sequential group). Parameters such as mean keratometry (K) values, axial length, IOL power, and corneal astigmatism were compared pre and postoperatively in the combined and sequential groups. 70 eyes of 70 patients were included in the present study. The mean age of the participants in the combined group was 70.46±10.12, whereas that in the sequential group was 68.68±11.22 (p=0.243). The mean horizontal length of the pterygium in the combined group was 2.64±0.17 mm and 2.57±0.17 mm in the sequential group. The mean postoperative K values (p=0.03) and IOL power (p=0.04) in the combined group were significantly higher than the preoperative values. The estimated postoperative refractive error in the combined group was -0.50±1.00 D and 0.25±0.5 D in the sequential group (p=0.04). On the other hand, the postoperative refraction in the sequential group was predictable. Corneal visibility was diminished on the nasal side in almost all the patients in the combined group as compared to the sequential group. The postoperative refraction errors were positively correlated with the length of pterygium in the combined group. The unpredictability of these errors recommends sequential surgery in cases with concurrent pterygium and cataract.
Topics: Biometry; Cataract; Cornea; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Phacoemulsification; Pterygium; Refraction, Ocular
PubMed: 34179581
DOI: 10.22336/rjo.2021.31 -
Graefe's Archive For Clinical and... Oct 2021To investigate the presence of HPV on the ocular surface after surgical excision of HPV infected pterygia and the possible correlation of HPV with pterygium...
PURPOSE
To investigate the presence of HPV on the ocular surface after surgical excision of HPV infected pterygia and the possible correlation of HPV with pterygium postoperative recurrence.
MATERIALS AND METHODS
Both exfoliative pterygium swab samples and respective tissue specimens were received and analyzed with real-time PCR for the detection of HPV-infected pterygia. In addition, swab samples from patients that had HPV-infected pterygia with no recurrence after 1 year of follow-up, as well as swab samples from patients with healthy conjunctiva, were analyzed.
RESULTS
Forty eyes with pterygium of 40 patients and 40 eyes with normal conjunctiva were included in the study. HPV virus was detected in the tissue specimens of 11 patients (27.5%) and in the swabs of 9 patients (22.5%). The HPV subtypes detected were 33, 39, 45, 56, 59, 66, and 68. The swab test had sensitivity of 81.82% and 100% specificity. In 15 (43%) patients, a bare sclera technique was used for pterygium removal and eleven of these patients showed recurrence of the disease. Surgical excision with use of autologous conjunctival graft was performed in twenty patients and five of them had recurrence. Patients with recurrent disease were 12.41 times more likely to have an HPV-infected pterygium (p = 0.031). Furthermore, from the 11 HPV positive patients, six had no recurrence, 1 year after surgery. In five of them, a swab sample was taken from the site of the surgical excision 1 year after surgery and real-time PCR was negative for HPV presence.
CONCLUSION
Persistence of HPV infection seems to be correlated with postoperative pterygium recurrence. Further investigation with the use of the minimally invasive proposed swab technique may contribute in the understanding of pterygium pathogenesis and in the development of a more efficient treatment planning.
Topics: Conjunctiva; Follow-Up Studies; Humans; Papillomavirus Infections; Pterygium; Recurrence; Sclera; Transplantation, Autologous; Treatment Outcome
PubMed: 34155561
DOI: 10.1007/s00417-021-05267-0 -
Expression of p53 and Ki-67 proteins in patients with increasing severity and duration of pterygium.Indian Journal of Ophthalmology Apr 2021Pterygium is a triangular fibrovascular subepithelial ingrowth of degenerative bulbar conjunctival tissue over the cornea. It is now considered to be a result of...
PURPOSE
Pterygium is a triangular fibrovascular subepithelial ingrowth of degenerative bulbar conjunctival tissue over the cornea. It is now considered to be a result of uncontrolled cellular proliferation as overexpression of p53 protein and Ki-67 nuclear protein was found in the epithelium. This study was done to find the expression of p53 and Ki-67 with the severity and duration of the pterygium to explain the etiopathogenesis.
METHODS
Data were analyzed from 43 Indian participants of all age groups. All patients were divided according to the severity of pterygium (mild, moderate, and severe groups) and according to the duration of pterygium (<4 years and >4 years). The samples were studied by immunohistochemistry by using antibodies against p53 and Ki-67 proteins considering >5% expression as significant.
RESULTS
Of 43 cases, p53 and Ki-67 expression were positive in 33 cases. In mild, moderate, and severe cases p53 positivity was 33.3%, 78.4%, 100%, respectively. P53 expression increased with duration, 79.3% positive in <4 years, and 92.9% positive in >4 years. With increasing severity of pterygium, mild, moderate, and severe cases, Ki-67 positivity was 66.7%, 78.37%, 66.7%, respectively. Ki-67 expression with duration, 79.3% positive in <4 years, and 85.7% positive in >4 years of the duration of pterygium with no statistical significance.
CONCLUSION
Our study revealed that with increasing duration and severity of pterygium, p53 expression was observed to be increasing. Ki-67 expression increased with the duration of pterygium but not with the severity.
Topics: Conjunctiva; Humans; Immunohistochemistry; India; Ki-67 Antigen; Pterygium; Tumor Suppressor Protein p53
PubMed: 33727444
DOI: 10.4103/ijo.IJO_1034_20 -
Survey of Ophthalmology 1988Pingueculae and pterygia are benign peribulbar lesions composed of degenerated basophilic subepithelial tissue. Pingueculae do not affect vision, and minor irritation... (Review)
Review
Pingueculae and pterygia are benign peribulbar lesions composed of degenerated basophilic subepithelial tissue. Pingueculae do not affect vision, and minor irritation can usually be managed with artificial tears. Pterygia may affect the visual axis and require surgical and adjunctive treatment. The various therapeutic strategies are reviewed. A conservative approach is advocated, as surgical removal of primary pterygia may result in recurrent ptergyia that are more difficult to manage than the primary lesions.
Topics: Conjunctival Diseases; Humans; Pterygium; Recurrence
PubMed: 3051468
DOI: 10.1016/0039-6257(88)90071-9