Tear Fluid and Serum Vitamin D Concentrations in Unilateral Pterygium.

SIGNIFICANCE: Vitamin D has antiangiogenic, anti-inflammatory, and antifibrotic properties, which may play an inhibitory role on pterygium formation. Vitamin D concentration was measured in few studies, and contradictory results have been reported. There is no study investigating tear fluid concentration of vitamin D in pterygium patients. PURPOSE: This study evaluated tear fluid and serum vitamin D concentrations of pterygium patients in comparison with healthy controls. METHODS: Thirty-five (21 male, 14 female) patients with unilateral pterygium and 25 (18 male, 7 female) healthy controls were included in this case-control study. After full ophthalmic examination, blood samples were taken, and basal tear fluid was collected using glass microcapillary tubes. Tear fluid and serum vitamin D concentrations were analyzed using enzyme-linked immunosorbent assay and analyzed statistically. RESULTS: The mean ± standard deviation age of patients was 51.7 ± 16.7 years in the study group and 50.6 ± 18.7 years in the control group, respectively (P = .82). The mean tear fluid vitamin D concentration was statistically significantly higher than the mean serum concentration in the study groups (P < .0001). The mean tear fluid (P = .76) and serum vitamin D concentrations (P = .53) did not reveal statistically significant difference between patients and controls. There was no statistically significant difference for tear fluid vitamin D concentration between pterygium eyes and fellow eyes (P = .93). The difference in concentrations was compared within the pterygium subgroups, and it was found that the mean serum vitamin D concentration trended toward lower values as the stage of pterygium increased, and the mean tear fluid vitamin D concentration trended toward higher values as the stage of pterygium increased, although these differences were not statistically significant (all, P > .05). CONCLUSIONS: Tear fluid and serum vitamin D concentrations do not seem to have a role in pterygium pathogenesis.

Association between pterygium, sun exposure, and serum 25-hydroxyvitamin in a nationally representative sample of Korean adults.

PURPOSE: Ultraviolet-B (UVB) light exposure is the major risk factor for developing a pterygium, and serum 25-hydroxyvitamin D (25(OH)D) level is an objective measure of UVB light exposure. In this study, we investigated the association between pterygium, sun exposure, and serum 25(OH)D. METHODS: This population-based, cross-sectional study comprised 12,258 adults (aged ≥19 years) participating in the fifth annual Korea National Health and Nutrition Examination Survey from 2010 to 2012. The enrolled subjects underwent interviews, clinical examinations, and laboratory investigations. The serum 25(OH)D levels were measured, and pterygium was examined by using a slit lamp. We used three adjusted logistic regression models and selected covariates as potential confounders. RESULTS: The overall prevalence of pterygium was 7.09, and 53.1% of these subjects were women. The prevalence of pterygium was higher in elderly subjects and those who lived at low latitudes. In multivariate analysis with adjustment for confounding factors, subjects with a serum 25(OH)D level > 30 ng/mL, 25-30 ng/mL, and 15-20 ng/mL had an odds ratio (OR) (95% confidence interval [CI]) of 1.565 (1.035-2.366), 1.545 (1.086-2.198), 1.8 (1.358-2.386), and 1.535 (1.216-1.938), respectively, compared to those with a serum 25(OH)D level < 15 ng/mL. Subjects with a daily sun exposure > 5 h had an OR (95% CI) of 1.761 (1.395-2.223) compared to subjects with a daily sun exposure < 2 h. CONCLUSION: The present study provides epidemiological evidence of an association of daily sun exposure and serum 25(OH)D levels with pterygium in a representative Korean population.

Association between Serum Immnunoglobulin E and Pterygium: A Population-Based Study from South Korea.

PURPOSE: Several studies have shown that pterygium is associated with inflammation, angiogenesis, and fibrosis. However, it should be acknowledged that not enough is known about the association between immunoglobulin E (IgE) and pterygium. The present study was conducted to test the hypothesis that elevated serum IgE is associated with a greater prevalence of pterygium. MATERIAL AND METHODS: A cross-sectional study was performed using data of 1,548 participants aged 30 years or older who were enrolled in the Korea National Health and Nutrition Examination Survey conducted in 2010. Multivariable logistic regression analysis was used to examine the relationship between pterygium and allergic conditions, including total serum IgE and allergen-specific serum IgE levels, after adjusting for potential confounding factors. RESULTS: Participants with pterygium were more likely have increased IgE level (p = 0.009). After adjusting for potential confounders, the odds ratio (OR) for pterygium was greater in participants with higher total serum IgE levels (OR = 1.63; p = 0.047). Multivariable-adjusted ORs of pterygium across the tertile of increasing IgE were 1.00 (reference), 1.18, and 1.45, (P for linear trend = 0.038). Although the ORs for the upper two tertiles of cockroach and dog allergen-specific IgE were higher than those for the lowest tertile, allergen-specific serum IgE showed no clear association with pterygium. CONCLUSIONS: Increased total serum IgE concentration is independently related to pterygium after adjusting for confounding factors. To the best of our knowledge, this study is the first research that reveals an association between serum IgE and pterygium.

[Pterygium surgery by conjunctiva autograft with autologous blood fixation]. / Chirurgie du ptérygion avec greffe de conjonctive fixée par du sang autologue.

INTRODUCTION: Pterygium surgery is marked by the possibility of recurrences; one of the techniques which results in the least recurrences is conjunctival autograft. Fixation of the conjunctiva had traditionally been accomplished with sutures. In recent years, conjunctival grafting has also been performed with fibrin glue. Even more recently, with a view towards improving the quality of postoperative results, some surgeons recommend the use of autologous blood. This study aims to evaluate the stability of this latest method of graft fixation, while assessing its postoperative results. METHODOLOGY: After diagnosis of pterygium, the patients underwent pterygium surgery with a conjunctival graft fixated with autologous blood. They were then monitored for one year, at 24h postoperatively, then seven days, 15 days, one month 3months, and every 3months thereafter. RESULTS: In totl, 84.21 % of the patients demonstrated stable postoperative fixation; 5.26 % of patients experienced significant displacement of the graft. After one year of follow-up, 15.79 % of patients experienced recurrent pterygium. Recurrences were more frequent in younger patients and in patients with previous recurrence. CONCLUSION: Pterygium surgery by conjunctival graft fixated with autologous blood is a safe surgery, with results similar to other pterygium surgery techniques with conjunctival autograft. However, this technique has the advantage less irritation, no risk of transmitting infection and lower cost.

Local pro-inflammatory cytokine and nitric oxide responses are elevated in patients with pterygium.

Pterygium is a common ocular surface disease observed in humans. Chronic ultraviolet (UV) exposure is extensively recognized as an aetiological factor in the pathogenesis of this disease. This hypothesis is sustained by epidemiological and histopathological data in relation to UV injured skin. Although some findings have indicated that genetic factors, anti-apoptotic and immunological mechanisms are involved in the pathogenesis of pterygium, the mechanism by which it develops remains poorly understood. In this study, we analysed the in vivo production of IL-17A, IL-6, IL-10 and nitric oxide (NO) in the tears and sera from Algerian patients. Interestingly, we observed that IL-6, IL-17A and NO production in the tears and sera of all patients was strongly associated with inflammatory infiltration, NOS2, NF-κB and Bcl2 expression in pterygia biopsies. Collectively, our results indicate a relationship between local inflammation and anti-apoptotic processes in pterygium disease, leading to both tissue damage and enhanced cellular proliferation.

Vitamin D level in patients with pterygium.

PURPOSE:: To evaluate blood vitamin D level in patients with pterygium. METHODS:: This prospective study, compared 58 eyes of 58 healthy individuals (control group) with 63 eyes of 63 patients with pterygium (study group). Subjects were stratified by time spent indoors or outdoors. Participants were given comprehensive ophthalmic examinations; blood 25-hydroxyvitamin D (nmol/L) was assayed. RESULTS:: Vitamin D level was significantly higher in men with pterygium than without it (p=0.020), but the difference was not significant in women (p=0.86). In the pterygium group, vitamin D level was significantly increased in participants with outdoor activity (p=0.010). In the control group, vitamin D levels did not differ significantly with indoor and outdoor activity (p=0.126). CONCLUSION:: Vitamin D level in participants with pterygium was significantly increased only in men and in those with more outdoor activity.

Vitamin D level in patients with pterygium / Níveis de vitamina D em pacientes com pterígio

ABSTRACT Purpose: To evaluate blood vitamin D level in patients with pterygium. Methods: This prospective study, compared 58 eyes of 58 healthy individuals (control group) with 63 eyes of 63 patients with pterygium (study group). Subjects were stratified by time spent indoors or outdoors. Participants were given comprehensive ophthalmic examinations; blood 25-hydroxyvitamin D (nmol/L) was assayed. Results: Vitamin D level was significantly higher in men with pterygium than without it (p=0.020), but the difference was not significant in women (p=0.86). In the pterygium group, vitamin D level was significantly increased in participants with outdoor activity (p=0.010). In the control group, vitamin D levels did not differ significantly with indoor and outdoor activity (p=0.126). Conclusion: Vitamin D level in participants with pterygium was significantly increased only in men and in those with more outdoor activity.

RESUMO Objetivo: Avaliar os níveis sanguíneos de vitamina D em pacientes com pterígio. Métodos: Neste estudo prospectivo e comparativo, foram incluídos 58 olhos de 58 indivíduos saudáveis (grupo controle) e 63 olhos de 63 pacientes com pterígio (grupo de estudo). Os indivíduos também foram categorizados quanto ao tempo foi gasto dentro de casa ou ao ar livre. Todos os participantes foram submetidos a exames oftálmicos e avaliações de nível sanguíneo 25-hidroxivitamina D (nmol/L). Resultados: O nível de vitamina D foi significativamente maior em pacientes masculinos com pterígio do que aqueles sem pterígio (p=0,020). Não houve diferença significativa entre mulheres do grupo de estudo e controle (p=0,86). No grupo pterígio, o nível de vitamina D foi significativamente maior no subgrupo com atividade ao ar livre (p=0,010). No grupo controle, o nível de vitamina D não foi significativamente diferente entre a atividade interna e ao ar livre (p=0,126). Conclusão: Os achados deste estudo revelaram que o nível de vitamina D nos casos de pterígio foi significativamente maior apenas nos homens e nos casos com maior atividade ao ar livre.

Positive Association between Blood 25-Hydroxyvitamin D Levels and Pterygium after Control for Sunlight Exposure.

PURPOSE: To investigate the association between blood 25-hydroxyvitamin D levels and pterygium. METHODS: Korean National Health and Nutrition Examination Survey 2008-2011 were used for the present epidemiologic study. A total of 19,178 participants aged ≥ 30 years were evaluated for blood 25-hydroxyvitamin D levels and performed ophthalmic slit lamp examinations. Pterygium was considered as a growth of fibrovascular tissue over the cornea. RESULTS: The average blood 25-hydroxyvitamin D levels were 18.6 ng/mL, and prevalence of pterygium was 6.5%. The odds of pterygium significantly increased across blood 25-hydroxyvitamin D quintiles after controlling sun exposure time as well as other confounders such as sex, age, smoking, diabetes, hypertension (P < 0.001). The odds ratios (OR) for pterygium was 1.51 (95% Confidence Interval[95%CI]; 1.19-1.92) in the highest blood vitamin D quintile. Stratified analysis by sex showed a positive association between blood 25-hydroxyvitamin D levels and pterygium in both men (quintile 5 versus 1, OR; 1.68, 95%CI; 1.19-2.37) and women (quintile 5 versus 1, OR; 1.37, 95% CI; 1.00-1.88). CONCLUSIONS: Even after controlling sun light exposure time, we found a positive association between blood 25-hydroxyvitamin D levels and pterygium in a representative Korean population. The mechanism underlying this association is unknown.

The ocular benefits of estrogen replacement therapy: a population-based study in postmenopausal Korean women.

PURPOSE: To elucidate the prevalence of cataract, glaucoma, pterygia, and diabetic retinopathy among Korean postmenopausal women with or without estrogen replacement therapy (ERT). METHODS: A cross-sectional, nationally representative sample from the 4th Korea National Health and Nutrition Examination Survey (KNHANES IV) (2007-2009) was used. Participants were interviewed for the determination of socioeconomic and gynecologic factors. Each woman also underwent an ophthalmologic examination and provided a blood sample for risk factor assessment. RESULTS: Of 3968 postmenopausal women enrolled, 3390 had never received estrogen, and 578 were undergoing estrogen treatment. After adjusting for age, diabetes, hypertension, high cholesterol levels, and high low-density lipoprotein levels, the prevalence of anterior polar cataract, retinal nerve fiber layer (RNFL) defect, and flesh pterygium was higher in the non-ERT group (OR, 3.24; 95% CI, 1.12-9.35, OR 1.70; 95% CI, 1.04-2.78, OR 3.725; 95% CI, 1.21-11.45, respectively). Further, the prevalence of atrophic pterygium was lower in the non-ERT group compared to that in the ERT group (OR, 0.21, 95% CI, 0.07-0.63). CONCLUSIONS: These data suggest that ERT has a protective effect against the development of anterior polar cataract, flesh pterygium, and RNFL defect.

[Vitamin A and carotene concentration in serum in persons with chronic conjunctivitis and pterygium]. / Vitamin-A-und Carotinkonzentrationen im Serum bei Personen mit chronischer Conjunctivitis und Pterygium

In 41 persons with chronic conjunctivitis, 28 persons with pterygium and 61 eye-healthy persons the Vitamin A and carotene blood level have been examined. All persons with chronic conjunctivitis and pterygium have subjective eye disturbances. In persons with chronic conjunctivitis the vitamin A blood level was lower (men 32 mcg%, women 20 mcg%). In almost all persons with chronic conjunctivitis and pterygium delayed dark adaptation was recorded and the skin-mucosal changes are more frequent.