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.
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.
Lluch, S.; Julio, G.; Pujol, P.; Merindano, M. Graefe's archive for clinical and experimental ophthalmology Vol. 254, num. 1, p. 143-148 DOI: 10.1007/s00417-015-3186-9 Data de publicació: 2016-01-01 Article en revista
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 hematoxylin–eosin (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.
Julio, G.; Lluch, S.; Pujol, P.; Merindano, M.; Marques, M.S. Optometry and vision science Vol. 92, num. 7, p. 790-795 DOI: 10.1097/OPX.0000000000000622 Data de publicació: 2015-07-01 Article en revista
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.
PurposeTo establish the sequence of tomographic changes in the tissue recovery process after pterygium excision and to propose healing indicators.; MethodsOptical coherence tomography (OCT) images were taken at 1week, 1, 3 and 6months after lesion excision in 73 eyes of 73 patients (33 male, 40 female; mean age 50, S.D. 5.0, range 40-70years) with primary nasal pterygium. Biomicroscopy was performed at each visit and at 12months, 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.; ResultsEleven 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 1month, 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 3months, 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 6months 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.; ConclusionsThe 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.
Pterygium is a common ocular surface lesion originates from altered limbal stem cells, which proliferate into the cornea, accompanied by degradation of Bowman’s layer and elastosis. Corneo-conjunctival changes could trigger tear film alterations that, in some conditions, reduce corneal sensitivity. The purpose of this study was to compare corneal sensitivity on affected and unaffected zone, thus assessing a relative loss of sensitivity.
Thirty-nine eyes of 39 patients with primary nasal pterygium were included in this study. Cochet-Bonnet aesthesiometer were used to evaluate corneal sensitivity of 3 points on pterygium lesion (delimiting a triangle) and 4 points on unaffected cornea (central, temporal, upper and lower). All the measurements were made for the same practitioner and in similar conditions of humidity and temperature. Results on one zone were added to calculate the sensitivity of this zone.
Abnormal sensitivity in the three point of the lesion was found in 35 eyes (89.74%) being the mean sensitive value of the affected zone 13.8 ± 2.8 cm (normal mean value of 18 cm, since the zone include 3 points and normal result is 6 cm in each point). Mean sensitivity in unaffected cornea was 23.5 ± 1.0 cm (normal mean values of 24 cm). Four eyes showed normal mean values in the two zones. A significant sensitivity reduction in the affected zone was found when results of the two zones were compared (p < 0.001; Wilcoxon test) (data were normalized to avoid influence of the different number of points analyzed in each zone). Pterygium changes seem to induce corneal sensitivity loss, regardless changes in tear film. (COI/financial disclosure: none)
Pujol, P.; Julio, G.; de Carvalho, A.M.; Kostov, B.; Martí , T. Optometry and vision science Vol. 91, num. 7, p. 747-751 DOI: 10.1097/OPX.0000000000000307 Data de publicació: 2014-07-01 Article en revista
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 9 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.
PURPOSE: To evaluate the effect of pterygium size and excision on corneal astigmatism before, after surgery.
METHODS: Thirty two eyes with pterygium, were operated using the limbal-conjunctival autograft technique. Corneal topography was performed preoperatively, one, and 3 months after the intervention.
RESULTS: A significant correlation (p < 0.05) was obtained berween pterygium length and preoperative astigmatism, but no correlation was observed berween length and astigmatism at any timepoint. A statistically significant reduction was found berween pre-surgical astigmatism and astigmatism at one and three months. No differences were observed berween one and 3 months. No significant differences were found when comparing the presurgical and postsurgical astigmatism axis.
CONCLUSIONS: Pterygium surgery with limbal-conjunctival autograft moderarely reduces corneal astigmatism. Preoperative astigmatism is associated with the size of the