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BACKGROUND:It has been reported that the application of biotic amniotic membrane and corneal bandage lens in pterygium surgery can significantly reduce the pain reaction after pterygium excision and promote the healing of corneal wounds. OBJECTIVE:To compare the efficacy of biotic amniotic membrane and corneal bandage lens on the repair of corneal wounds and neuropathic pain after pterygium surgery. METHODS:A total of 121 cases(142 eyes)of primary pterygium patients admitted to Nanyang Second People's Hospital from August 2020 to May 2022 were retrospectively selected.They all underwent pterygium excision combined with autogenous free conjunctival flap transplantation.Among them,63 cases(68 eyes)of pterygium postoperative wound repair with biotic amniotic membrane were classified as the amniotic membrane group,and 58 cases(74 eyes)of pterygium wound repair with corneal bandage lens were classified as the bandage lens group.Postoperative follow-up was conducted,and the corneal wound repair of the patients within 2 weeks after surgery was recorded.Neuropathic pain was quantified by Wong-Baker face on the day after surgery,1 day,and 2 weeks after surgery.The corneal topographic map indicating asymmetry index,best corrected visual acuity,corneal refractive index,and surface rule index were recorded before surgery,1 and 3 months after surgery. RESULTS AND CONCLUSION:(1)2 weeks after treatment,the wound repair rate in the bandage lens group was significantly higher than that in the amniotic membrane group(P<0.05).The wound healing time was shorter in the bandage lens group than that in the amniotic membrane group(P<0.01).(2)The degree of neuropathic pain in the bandage lens group was lower than that in the amniotic membrane group on the day and 1 day after surgery(P<0.001),and there was no significant difference between the two groups in neuropathic pain at 2 weeks after surgery(P>0.05).(3)The corneal topographic map indicating asymmetry index,best corrected visual acuity,corneal refractive index,and surface rule index were significantly improved in both groups 1 and 3 months after surgery(P<0.05).The corneal topographic map indicating asymmetry index,corneal refractive index,and surface rule index of the bandage lens group were lower than those of the amniotic membrane group 1 and 3 months after surgery(P<0.05).(4)Recurrence occurred in 1 eye(1.47%)in the amniotic membrane group and 3 eyes(4.05%)in the bandage lens group within 3 months after operation,and there was no significant difference between the groups(P>0.05).(5)These findings suggest that the corneal bandage lens is more effective than the biotic amniotic membrane in the repair of corneal wounds after pterygium surgery.
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Objective To prepare a nano drug(PFOB@Lip-MMC)with liposome as the carrier,liquid perfluorooc-tyl bromide(PFOB)as core and mitomycin C(MMC)loading on the liposome shell and study its inhibitory effect on the proliferation of human pterygium fibroblasts(HPFs).Methods The thin film dispersion-hydration ultrasonic method was used to prepare PFOB@Lip-MMC and detect its physical and chemical properties.Cell Counting Kit-8,Cam-PI cell viability staining and flow cytometry were employed to detect the impact of different concentrations of PFOB@Lip-MMC on the via-bility of HPFs.DiI fluorescence labeled PFOB@Lip-MMC was used to observe the permeability of the nano drug to HPFs under a laser confocal microscope.After establishing HPF inflammatory cell models,they were divided into the control group(with sterile phosphate-buffered saline solution added),PFOB@Lip group(with PFOB@Lip added),MMC group(with MMC added),PFOB@Lip-MMC group(with PFOB@Lip-MMC added)and normal group(with fresh culture medi-um added)according to the experimental requirements.After co-incubation for 24 h,flow cytometer was used to detect the apoptosis rate of inflammatory cells,and the gene expression levels of interleukin(IL)-1β,prostaglandin E2(PGE2),tumor necrosis factor(TNF)-α and vascular endothelial growth factor(VEGF)in cells were analyzed by PCR.Results The average particle size and Zeta potential of PFOB@Lip-MMC were(103.45±2.17)nm and(27.34±1.03)mV,respec-tively,and its entrapped efficiency and drug loading rate were(72.85±3.28)%and(34.27±2.04)%,respectively.The sustained-release MMC of drug-loaded nanospheres reached(78.34±2.92)%in vitro in a 24-hour ocular surface environ-ment.The biological safety of PFOB@Lip-MMC significantly improved compared to MMC.In terms of the DiI fluorescence labeled PFOB@Lip-MMC,after co-incubation with inflammatory HPFs for 2 h,DiI fluorescence labeling was diffusely dis-tributed in the cytoplasm of inflammatory HPFs.The apoptosis rate of inflammatory HPFs in the PFOB@Lip-MMC group[(77.23±4.93)%]was significantly higher than that in the MMC group[(51.62±3.28)%].The PCR examination results showed that the gene transcription levels of IL-1 β,PGE2,TNF-α and VEGF in other groups were significantly reduced com-pared to the control group and PFOB@Lip group,with the most significant decrease in the PFOB@Lip-MMC group(all P<0.05).Conclusion In this study,a novel nano drug(PFOB@LIP-MMC)that inhibited the proliferation of HPFs was successfully synthesized,and its cytotoxicity was significantly reduced compared to the original drugs.It has good bio-compatibility and anti-inflammatory effects,providing a new treatment approach for reducing the recurrence rate after pte-rygium surgery.
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AIM:To observe the clinical efficacy of 3% diquafosol sodium eye drops combined with sodium hyaluronate eye drops in the treatment of dry eyes after pterygium surgery with lacrimal insufficiency.METHODS: A total of 64 cases(64 eyes)of pterygium patients with lacrimal insufficiency were treated with pterygium resection combined with limbal stem cell transplantation, and they were given routine anti-inflammatory and infection prevention treatment postoperatively. In terms of postoperative dry eye treatment, all patients were randomly divided into two groups. The observation group was treated with 3% diquafosol sodium eye drops combined with sodium hyaluronate eye drops, and the control group was treated with sodium hyaluronate eye drops. The break-up time of tear film(BUT), fluorescein(FL), Schirmer's Ⅰ test(SⅠt), ocular surface disease index(OSDI)score, central corneal thickness(CCT)changes, adverse reactions and complications were observed and compared between the two groups at different times postoperatively.RESULTS: Both groups of pterygium patients were accompanied with mild to moderate dry eyes with insufficient tear secretion preoperatively. At 2 wk after operation, both groups showed shorter BUT and higher FL score compared with those preoperatively(P<0.05). There was no significant difference between the two groups(P>0.05). At 4 wk after operation, BUT in the observation group was prolonged, OSDI score was decreased(both P<0.05), and FL score in both groups was decreased compared with those at with 2 wk after operation(P<0.05). The observation group was better than the control group(P<0.05). At the first day after operation, the CCT of the two groups was thicker than that preoperatively(P<0.05), and there was no significant difference in SⅠt between the two groups before and after operation(P>0.05).CONCLUSION: In the treatment of dry eye after pterygium surgery with lacrimal insufficiency, 3% diquafosol sodium eye drops combined with sodium hyaluronate eye drops can effectively reduce the postoperative dry eye symptoms, and its clinical effect is better than that of sodium hyaluronate eye drops alone.
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AIM: To investigate the preoperative ocular symptoms and the characteristics of asymptomatic ocular surface abnormalities in hospitalized patients with primary pterygium.METHODS: Cross-sectional study. Hospitalized patients diagnosed with primary pterygium and scheduled to receive pterygium excision surgery at the Xiamen Eye Center of Xiamen University from August 2022 to October 2022 were enrolled. Ocular surface disease index questionnaire(OSDI), six examinations including non-invasive tear film break-up time, Schirmer I test, tear meniscus height, lid margin abnormality, meibomian gland dropout and tear film lipid layer thickness, and anterior segment optical coherence tomography(AS-OCT)were performed and statistically analyzed.RESULTS: A total of 178 cases(178 eyes), with a mean age of 54.39±10.75 years old, were recruited, including 75 males(42.1%)and 103 females(57.9%). The average values of ocular surface parameters in these patients included OSDI: 11.47±9.69, tear film break-up time: 7.10±3.86 s; tear meniscus height: 0.16±0.07 mm, Schirmer I test values: 14.39±7.29 mm/5 min, and pterygium thickness: 504.74±175.87 μm. Totally 161 eyes(90.4%)presented with abnormal lid margin, 44 eyes(24.7%)presented with meibomian gland dropout score ≥4, 52 eyes(29.2%)presented with low lipid layer thickness. In the 6 objective examinations, abnormalities in at least 4 of these tests were found in 85.4% of eyes. Pterygium morphology was classified into four grades: 10 eyes(5.6%)of grade Ⅰ, 93 eyes(52.2%)of grade Ⅱ, 60 eyes(33.7%)of grade Ⅲ, and 15 eyes(8.4%)of grade Ⅳ. In patients with a higher grade of pterygium, the tear film break-up time was lower, and the proportion of abnormal lid margin was also significantly higher(P&#x003C;0.05). The patients were further divided into two subgroups, including 121 eyes(68.0%)with normal OSDI &#x003C;13 in the normal group and 57 eyes(32.0%)with OSDI ≥13 in the abnormal group. No significant difference was found in the proportion of meibomian gland dysfunction between the two groups of patients(71.9% vs. 71.9%, P=0.872). In addition, there were differences in the number of abnormal objective examinations(4.11±0.85 vs. 4.91±0.99, P&#x003C;0.001).CONCLUSIONS: Asymptomatic ocular surface abnormalities were present preoperatively in patients hospitalized for primary pterygium. A comparable high incidence of structural or functional meibomian gland dysfunction existed in pterygium patients with or without apparent ocular discomfort. More attention should be paid to the ocular surface abnormalities in those asymptomatic patients before primary pterygium surgery.
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RESUMEN Objetivo: Comparar dos técnicas quirúrgicas para extirpar el pterigión, mediante la evaluación de la sintomatología postoperatoria y la incidencia de la recidiva. Métodos: Ensayo clínico controlado aleatorizado con dos grupos paralelos y diseño simple ciego en 80 pacientes con pterigión primario de la Clínica Oftalmológica de la Selva. El primer grupo consideró la técnica de autoplastia fijada con cauterio bipolar (n=40) y el segundo la técnica convencional de autoplastia fijada con puntos (n=40). Se evaluaron los síntomas a las 72 horas postoperatorias y la recidiva a los seis meses. Resultados: A las 72 horas postcirugía el 6 % de los operados con la técnica electrocauterio presentaron sintomatología en comparación a un 41 % de los operados con sutura (p<0,05). Se evidenció recurrencia de 1 caso en el grupo de electrocauterio y 4 en el grupo de sutura (2,5 % vs. 10 %, p<0,05). Conclusiones: La técnica con cauterio demostró una recuperación más favorable, con menor sintomatología y recurrencia en comparación a la técnica convencional. Estos hallazgos sugieren que la técnica con cauterio puede ser más efectiva y mejor tolerada en pacientes de este estudio.
ABSTRACT Objective: To compare two surgical techniques for excising pterygium, by evaluating postoperative symptoms and the incidence of recurrence. Methods: Randomized controlled clinical trial with two parallel groups and a single-blind design involving eighty patients with primary pterygium from the Ophthalmological Clinic of the Jungle. The first group considered the autograft fixation technique with bipolar cautery (n=40), and the second group considered the conventional autograft fixation technique with sutures (n=40). Symptoms were assessed at 72 hours postoperatively, and recurrence was evaluated at six months. Results: At 72 hours post-surgery, 6% of patients operated with the electrocautery technique exhibited symptoms, compared to 41% of those operated with sutures (p < 0.05). Recurrence was observed in 1 case in the electrocautery group and 4 in the suture group (2.5% vs. 10%, p < 0.05). Conclusions: The cautery technique demonstrated a more favorable recovery, with fewer symptoms and recurrence compared to the conventional technique. These findings suggest that the cautery technique may be more effective and better tolerated in patients in this study.
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Objetivo: Determinar la efectividad de 5-Fluorouracilo intralesional en el alivio sintomático, astigmatismo y deseo de cirugía en pacientes con pterigión primario. Métodos: Estudio experimental realizado entre enero y marzo de 2020 en la Unidad de Oftalmología del Hospital del Salvador, Chile. Se seleccionaron 14 ojos (14 pacientes) en lista de espera quirúrgica, expuestos a inyecciones intralesionales quincenales de 10 mg de 5-FU. Se realizó una evaluación clínica inicial con OSDI para medición sintomática, cámara fotográfica y lámpara de hendidura para apariencia clínica, y autorrefractómetro para astigmatismo, siendo reevaluados 60 días después, añadiéndose la pregunta de si mantenían el deseo de operarse. Se dividió la muestra en grupo A y B según recibieron dos o una dosis de 5-FU, respectivamente. Resultados: La edad promedio de los participantes fue 56,8 ± 11,1 años. El grupo A presentó un OSDI inicial de 50 ± 23,8 que, posterior a la intervención, se redujo a 21 ± 13,5 (p < 0,001). El grupo B tuvo un OSDI inicial de 47 ± 17,3, disminuyendo a 22 ± 16,2 (p < 0,005). Ambos cambios estadísticamente significativos. En cuanto al aspecto físico, hubo reducción del tamaño lesional en 2 de los 14 pacientes, ambos del grupo A. No hubo cambios respecto al grado de astigmatismo. Hubo 2 pacientes que decidieron no realizarse la cirugía posterior a la intervención. Conclusión: La inyección intralesional de 5-FU demostró mejoría significativa en el alivio sintomático, sin complicaciones asociadas, generando un tratamiento alternativo al quirúrgico en pacientes con pterigión primario, pudiendo posponer la cirugía.
Objectives: To determine the effectiveness of intralesional 5-Fluorouracil (5-FU) in symptomatic relief, astigmatism, and desire for surgery in patients with primary pterygium. Methods: The experimental study was carried out between January and March 2020 in the Ophthalmology Unit of the Hospital del Salvador, Chile. Fourteen eyes (14 patients) were selected on the surgical waiting list and exposed to fortnightly intralesional injections of 10 mg of 5-FU. An initial evaluation was performed with OSDI for symptomatic measurement, a photographic camera and slit lamp for clinical appearance, and an auto-refractometer for astigmatism, being re-evaluated 60 days later, adding the question of whether they maintained the desire to undergo surgery. The sample was divided into groups A and B depending on whether they received two or one dose of 5-FU, respectively. Results: The average age of the participants was 56.8 ± 11.1 years. Group A presented an initial OSDI of 50 ± 23.8, which, after the intervention, decreased to 21 ± 13.5 (p < 0.001). Group B had an initial OSDI of 47 ± 17.3, decreasing to 22 ± 16.2 (p < 0.005)-statistically significant changes. The degree of astigmatism had no changes. Regarding the physical aspect, there was a reduction in the size of the lesion in 2 of the 14 patients, both in group A. Two patients decided not to undergo surgery after the intervention. Conclusions: The intralesional injection of 5-FU showed a significant improvement in symptomatic relief without associated complications, generating a therapeutic alternative in patients with primary pterygium without surgical indication.
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Abstract Escobar syndrome is a rare, autosomal recessive disease of unknown incidence. It is characterized by multiple skeletal, genitourinary and orofacial abnormalities. The multiple malformations (mainly orofacial) and restricted mobility of these patients pose a challenge to the anesthesia team, especially as regards airway management. We describe the clinical case of a pediatric patient diagnosed with Escobar syndrome who underwent two consecutive anesthesia interventions, with evidence of progressive airway anomalies that characterize this syndrome. The case required adaptation, according to the clinical stage of the disease, of the current algorithms used to approach an anticipated difficult airway in pediatrics, and the incorporation of new devices, not described so far in patients with this pathology, as part of the planning and execution phases.
Resumen El síndrome de Escobar es una enfermedad rara, autosómica recesiva, de incidencia desconocida. Se caracteriza por múltiples anomalías esqueléticas, genitourinarias y orofaciales. Las múltiples malformaciones (principalmente orofaciales) y la restricción de la movilidad de estos pacientes determinan un desafío para el equipo anestésico, especialmente en el manejo de la vía aérea. Se describe el caso clínico de una paciente pediátrica con diagnóstico de síndrome de Escobar que fue sometida a dos anestesias consecutivas, en el que se evidencia una progresión de las anomalías de la vía aérea propias del síndrome, por lo que se requiere adecuar, según el estadío clínico de la enfermedad, los algoritmos actuales de abordaje de vía aérea difícil pediátrica anticipada y la incorporación de nuevos dispositivos en la planificación y ejecución para su manejo que no han sido descritos en pacientes con esta patología.
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Purpose: Pterygium is a fibrovascular disease that originates in the conjunctiva and commonly spreads to the corneal surface, thereby posing a threat to eyesight. Despite intensive research, the pathophysiology of this disease remains unclear. Recent research suggests that oncogenic viruses, such as human papillomavirus (HPV), cytomegalovirus, and Epstein–Barr virus (EBV), may play a role in pterygia development. Although there are questions concerning the function of oncogenic viruses in pterygium pathogenesis, existing research shows a lack of consensus on the subject, demonstrating the heterogeneity of pterygium pathophysiology. Therefore, we aimed to simultaneously detect the three common viral pathogens that have been reported in pterygium tissue obtained after excision. Methods: Thirty?five tissue specimens of pterygium from patients undergoing pterygium surgery (as cases) were analyzed for evidence of viral infection with multiplex polymerase chain reaction (PCR), and virus?specific real?time quantitative PCR was used for the samples that were detected positive by multiplex PCR. Results: Of the 35 patients, one sample was positive for EBV and two samples were positive for HPV. Further PCR?based DNA sequencing of the HPV PCR?positive product showed identity with HPV?16. Real?time quantitative PCR on samples that showed EBV or HPV positivity did not yield any detectable copy number. Conclusion: Our study results confirmed that PCR positivity could be due to transient flora, but it was not quantitatively significant to conclude as the causative factor of pterygium pathogenesis. However, additional studies with larger sample populations are warranted to fully determine the role of the virus in pterygium.
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Objective:To investigate the regulation of transcription factor CCCTC binding factor (CTCF) on the expression of B-cell lymphoma 2 ( Bcl-2) gene in pterygium and its molecular mechanism. Methods:Pterygium tissue samples from 22 primary pterygium patients who underwent pterygium excision combined with autologous limbal stem cell transplantation in The First Hospital of Changsha from June 2017 to February 2019 were collected during the operation as pterygium group.Normal conjunctival tissue from 20 patients with ocular trauma due to conjunctiva rupture, eyeball rupture or eyeball perforation in the same period were collected during the repair of ocular trauma as control group.Real-time PCR and Western blot were used to detect the expression levels of CTCF and Bcl-2 in the two groups.The DNA methylation level of the Bcl-2 promoter in the samples of the two groups was detected by bisulfite sequencing PCR (BSP). Pterygium fibroblasts were isolated and cultured.Fibroblasts were identified by immunohistochemistry using vimentin antibody.The cultured pterygium fibroblasts were divided into a CTCF interference group transfected with CTCF interference plasmid, and a control group transfected with control plasmid.The expression levels of CTCF and Bcl-2 in pterygium fibroblasts in CTCF interference and control groups were detected by real-time PCR and Western blot.The cell vitality was detected with cell counting kit-8 at 12, 24, and 48 hours after transfection.The DNA methylation level of the Bcl-2 promoter in the cells of the CTCF interference and control groups after transfection was determined by BSP.Differences of the indexes among groups were analyzed.Correlation between Bcl-2 mRNA and Bcl-2 gene promoter methylation level of CTCF protein in pterygium tissue was analyzed by Pearson linear correlation analysis.This study protocol was approved by the Ethics Committee of The First Hospital of Changsha (No.KL-2017021). Written informed consent was obtained from the patients from whom the specimens were collected.Results:The relative expression levels of CTCF mRNA and protein in pterygium group were 7.23±3.34 and 0.92±0.21, respectively, which were significantly higher than 1.10±0.44 and 0.28±0.07 in normal conjunctiva group ( t=-8.136, -13.025; both at P<0.01). The relative expression levels of Bcl-2 mRNA and protein in pterygium group were 10.27±4.64 and 0.95±0.27, which were higher than 1.10±0.41 and 0.32±0.14 in normal conjunctiva group, showing statistically significant differences ( t=-8.789, -10.782; both at P<0.01). The CTCF protein expression was significantly positively correlated with the Bcl-2 mRNA expression in pterygium group ( r=0.746, P<0.01). The DNA methylation level of the Bcl-2 promoter in pterygium group was 0.65±0.09, which was lower than 0.83±0.06 in normal conjunctiva group, with a statistically significant difference ( t=7.408, P<0.01). The DNA methylation level was significantly negatively correlated with the Bcl-2 mRNA expression in pterygium group ( r=-0.635, P<0.01). After the interference of CTCF expression in pterygium fibroblasts, the relative expression levels of CTCF and Bcl-2 mRNA in CTCF interference group were 0.37±0.03 and 0.53±0.06, which were significantly lower than 1.02±0.06 and 0.99±0.07 in control group ( t=20.035, 9.029; both at P<0.01). The relative expression levels of CTCF and Bcl-2 proteins in CTCF interference group were 0.23±0.06 and 0.56±0.07, which were lower than 0.52±0.05 and 0.92±0.12 in control group, showing statistically significant differences ( t=6.914, 4.719; both at P<0.01). The cell viability of pterygium fibroblasts in CTCF interference group was 0.10±0.01, 0.17±0.01, 0.38±0.04 at 12, 24, and 48 hours after interference, respectively, which were lower than 0.12±0.01, 0.29±0.01 and 0.85±0.06 in control group, and the differences were statistically significant ( t=3.718, 18.350, 15.621; all at P<0.01). The DNA methylation level of Bcl-2 promoter in CTCF interference group was 0.75±0.04, which was significantly higher than 0.61±0.03 in control group ( t=-4.472, P<0.05). Conclusions:CTCF is excessively expressed in pterygium, which may mediate the overexpression of Bcl-2 through down-regulating DNA methylation level.
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AIM:To analyze the efficacy of modified pterygium resection combined with conjunctival autograft transplantation(CAT)in the treatment of pterygium.METHODS: A total of 140 patients(154 eyes)with pterygium treated in the ophthalmology department of our hospital from January 2018 to January 2021 were selected and grouped according to random number table method. In the observation group, 70 cases(76 eyes)were treated with modified pterygium excision combined with CAT, and improved iris restorer was used during the operation. In the control group, 70 patients(78 eyes)were treated with conventional pterygium excision combined with CAT, during which traditional iris restorer was used. Follow up for 1a, the postoperative vision, subjective symptoms, conjunctival signs(conjunctival congestion and chemosis), corneal epithelial healing, postoperative complications and recurrence rate were compared between the two groups.RESULTS: Compared with pre-operation, vision of the two groups decreased significantly on 1, 3 and 5d after operation(P&#x003C;0.05), while there was no statistically significant difference between the groups(P&#x003E;0.05). Compared with 1d after operation, the scores on subjective symptoms, conjunctival hyperemia and edema in the two groups decreased significantly on 3, 5 and 14d after operation(P&#x003C;0.05), and those scores of the observation group on 3, 5 and 14d after operation were significantly lower than those of control group(P&#x003C;0.05).The corneal fluorescein staining(FL)scores of the observation group on 3, 5 and 14d after operation were significantly lower than those of the control group(P&#x003C;0.05). The proportion of repair time of corneal epithelial defect ≤5d in the observation group was significantly higher than that in the control group(P&#x003C;0.05). The incidence rates of conjunctival granuloma, symblepharon, and the recurrence rate in the observation group were significantly lower than those in the control group(P&#x003C;0.05).CONCLUSION: Modified pterygium resection combined with CAT is effective in the treatment of pterygium, which can alleviate postoperative irritative symptoms, conjunctival congestion and edema, and it is more conducive to postoperative corneal epithelial reconstruction, reduction of postoperative complications and recurrence rate.
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AIM: To investigate the effects of curcumin on the proliferation and apoptosis and migration of human pterygium fibroblasts(HPF)in vitro.METHODS: A total of 7 cases of pterygium tissue removed at our hospital from November 24, 2021 to December 16, 2021 were collected. Then, primary fibroblasts were cultured in vitro and identified by immunofluorescence staining. HPF were treated with 0, 10, 20, 40, 80 and 160μmol/L curcumin containing equal amount of dimethyl sulfoxide for 24h, then the cell proliferation was detected by CCK8 assay. According to the results of CCK8, the cells were divided into control group, 20μmol/L curcumin group and 40μmol/L curcumin group, and the cells were treated with corresponding concentration of curcumin for 24h in each group. Flow cytometry was used to detect apoptosis, Transwell migration assay was used to detect cell migration, and real-time fluorescence quantitative polymerase chain reaction and Western blot were used to detect the expression of mRNA and protein of B-cell lymphoma-2 associated X protein(Bax), B-cell lymphoma-2(Bcl-2), Cyclin D1 and matrix metalloproteinase 2(MMP2).RESULTS: Compared with the control group, both 20μmol/L curcumin group and 40μmol/L curcumin group can inhibit the proliferation and migration of HPF and induce its apoptosis(all P<0.05). Compared with the control group, 20μmol/L curcumin group can down-regulate the mRNA expression of Cyclin D1 and MMP2, up-regulate the mRNA expression of Bax, and down-regulate the protein expression of Bcl-2(all P<0.05). Compared with the control group, 40μmol/L curcumin group can down-regulate the expression of mRNA and protein of Bcl-2, Cyclin D1 and MMP2, and up-regulate the expression of mRNA and protein of Bax(all P<0.05). Compared with 20 μmol/L curcumin group, the 40 μmol/L curcumin group can down-regulate the mRNA expression of MMP2, down-regulate the protein expression of Bcl-2, and up-regulate the mRNA and protein expression of Bax(all P<0.05).CONCLUSION: Curcumin can inhibit the proliferation of HPF by inhibiting the expression of Cyclin D1, induce the apoptosis of HPF by down-regulating Bcl-2 and up-regulating the expression of Bax, and inhibit the migration of HPF by down-regulating the expression of MMP2.
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Purpose: To assess the autofluorescence size and properties of pterygium and pinguecula by anterior segment autofluorescence (AS-AF) imaging and demonstrate the difference of autofluorescence size presented in AS-AF imaging compared to the extend size of the conjunctival lesion measured by anterior segment slit-lamp photography (AS-SLE). Methods: Twenty-five patients with primary pterygium and twenty-five with pinguecula were included in the study. In addition, 25 normal subjects were also enrolled as the control group. The AS-AF characteristics of pterygium and pinguecula lesions were analyzed. The size of lesions displayed in the AS-SLE photography versus the AS-AF images were also compared. AS-AF images were obtained using a Heidelberg retina angiograph which focused on the anterior segment. AS-SLE photography was acquired using a digital imaging system (BX900 HAAG STREIT). Results: There were 44 (58.7%) male and 31 (41.3%) female patients; 19 (76%) and 20 (80%) patients had bilateral pterygium and pinguecula, respectively. All pinguecula lesions reflected hyperautofluorescence pattern in the AS-AF imaging. In 24 (96%) patients, the hyperautofluoresecence pattern was larger than the size of the clinical lesions displayed with the AS-SLE photography. Twenty-one (84%) patients with pterygium reflected a hyperautofluorescence pattern in AS-AF images; in one (4%) patient, the hyperautofluorescence pattern was larger than the clinical lesion size and four (16%) patients had no autofluorescence patterns in the AS-AF images. In the control group, in 14 (56%) subjects, a hypoautofluorescent pattern was revealed in the conjunctiva in AS-AF images. However, in 11 (44%) patients, hyperautofluorescence patterns were detected. Conclusion: AS-AF is a useful modality to monitor vascularization in conjunctival lesions. Pingueculae and pterygium show hyperautofluorescence in AS-AF imaging. The real size of the pinguecula lesions may be estimated with AS-AF characteristics, mostly presenting larger than the area size in AS-SLE photography. The autofluorescence size of the pterygium is smaller than the extent of visible pterygium in slit-lamp photography.
Sujets)
Imagerie optique , Ptérygion , Infections de l'oeil , PinguéculaRésumé
ABSTRACT Objective Compare the thickness of conjunctival autografts in pterygium surgery using the Moscovici dissection technique with manual dissection and assess the difficulty of the techniques. Methods In this randomized clinical trial, 30 eyes of 30 patients undergoing pterygium surgery were divided into the Moscovici Dissection Technique Group and the Manual Dissection Group. The patients were treated at the Hospital Oftalmológico Visão Laser (Santos, São Paulo, Brazil). Optical coherence tomography was performed to measure graft thickness three months postoperatively. Three images were obtained from each eye, and three measurements were taken at a distance of 1.5mm perpendicular to the limbus in each capture. The surgeon graded the difficulty of obtaining the graft with the technique performed from one (lowest difficulty) to four (highest difficulty). Results We found statistically significant difference between the difficulty of the two techniques and the mean conjunctival autograft thickness in the two groups (p=0.01 e p=0.05, respectively). The average difficulty rating for the Moscovici Dissection Technique Group (Air Group) was 1.47, while that for the Manual Dissection Group (MD group) was 2.20. The mean thickness of the three measurements was 252µ in the Air Group and 298µ in the MD Group, with medians of 250µ and 278µ, respectively. Conclusion Our study showed that the Moscovici technique results in thinner grafts and can be performed with greater surgical ease.
RESUMO Objetivo Comparar a espessura de autoenxertos conjuntivais em cirurgia de pterígio utilizando a técnica de dissecção de Moscovici com a de dissecção manual e avaliar a dificuldade das técnicas. Métodos Neste ensaio clínico randomizado, 30 olhos de 30 pacientes submetidos à cirurgia de pterígio foram divididos em um Grupo de Técnica de Dissecção de Moscovici e um Grupo de Dissecção Manual. Os pacientes foram tratados e avaliados no Hospital Oftalmológico Visão Laser (Santos, São Paulo, Brasil). A tomografia de coerência óptica foi realizada para medir a espessura do enxerto 3 meses após a cirurgia. Três imagens foram obtidas de cada olho, e três medidas foram realizadas a uma distância de 1,5mm perpendicular ao limbo em cada captura. O cirurgião classificou a dificuldade de obtenção do enxerto com a técnica realizada de um (menor dificuldade) para quatro (maior dificuldade). Resultados Encontramos diferenças estatisticamente significantes entre a dificuldade das duas técnicas e a espessura média do autoenxerto conjuntival nos dois grupos (p=0,01 e p=0,05, respectivamente). A classificação média de dificuldade para o Grupo de Técnica de Dissecção de Moscovici foi de 1,47, enquanto a do Grupo de Dissecção Manual foi de 2,20. A espessura média das três medidas foi de 252μ no Grupo de Técnica de Dissecção de Moscovici e de 298μ no Grupo de Dissecção Manual, com medianas de 250μ e 278μ, respectivamente. Conclusão Nosso estudo mostrou que a técnica de Moscovici resulta em enxertos mais finos e pode ser realizada com maior facilidade cirúrgica.
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Humains , Mâle , Femelle , Adulte d'âge moyen , Procédures de chirurgie ophtalmologique/méthodes , Transplantation autologue/méthodes , Ptérygion/chirurgie , Conjonctive/transplantation , Acuité visuelle , Conjonctive/anatomopathologie , Tomographie par cohérence optique , Autogreffes/anatomopathologie , Biomicroscopie , Pression intraoculaireRésumé
This paper aims to delve deeply into the practical guidelines for the application of artificial intelligence(AI)in the diagnosis of anterior ocular diseases in ophthalmology. Given the complexities and variability inherent in the images associated with the research of anterior segment diseases, AI has traditionally found its principal application in the sphere of posterior segment diseases within ophthalmology. However, with the evolution and advancement of AI technologies, notably machine learning and deep learning, alongside an exponential surge in anterior segment electronic image data, the implementation of AI in the domain of corneal, conjunctival, lens, and eyelid disease is not only feasible but has become a reality. The Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association, in tandem with the Ophthalmology Professional Committee of the International Translational Medicine Association, have orchestrated a consortium of experts. These specialists have synthesized the most recent progressions, both nationally and internationally, in the application of AI in the diagnosis of anterior ocular diseases. This includes its use in corneal, conjunctival, lens, and eyelid diseases, and provides an analysis of the current challenges faced as well as the future directions of development. This guideline has been formulated through several iterations of thoughtful discussion and revisions. Its purpose is to empower clinical ophthalmologists with a reliable framework to facilitate the enhanced application of AI in diagnostic decision-making and clinical research for anterior ocular diseases.
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AIM: To investigate the effect of modified Chufeng Yisun Decoction on ocular surface inflammation after pterygium surgery.METHODS: A total of 60 patients(60 eyes)with primary pterygium who underwent pterygium surgery were randomly divided into control group and study group, with 30 cases(30 eyes)in each group. In the control group, patients were treated with pranoprofen eye drops, tobramycin dexamethasone eye drops, and deproteinized calf blood extract eye gel after the surgery. In the study group, patients were treated by oral modified Chufeng Yisun Decoction in addition to the treatments in the control group. The changes of ocular irritation symptoms, ocular inflammatory signs, tear interleukin 6(IL-6)levels, and tear ferning test(TFT)of patients in the two groups were assessed.RESULTS: The visual analogue scale(VAS)in patients of both groups was significantly lower at 2d and 1wk after the surgery than that at 1d after the surgery(all P&#x003C;0.01), and the VAS of the study group was significantly better than that of the control group at 2d and 1wk after surgery(P&#x003C;0.01). The ocular signs integrals(OSI)and TFT results of both groups at 1wk were significantly lower than those at 1d after the surgery(all P&#x003C;0.01), and the OSI and TFT were also lower in the study group than in the control group at 1wk after the surgery(all P&#x003C;0.01). In addition, the concentration of tear IL-6 in both groups was significantly lower at 1wk after the surgery than 1d after the surgery(all P&#x003C;0.01), and it was also significantly lower in the study group than in the control group at 1wk after the surgery(P&#x003C;0.05).CONCLUSION: The combination of Chufeng Yisun Decoction and conventional treatment of western has a better effect on controlling ocular surface inflammation after pterygium surgery.
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AIM:To assess the clinical efficacy of 5-fluorouracil(5-FU)and bandage contact lens in the pterygium excision combined with autogenous limbal stem cell transplantation(ALSCT)in treating patients with pterygium.METHODS:Random controlled clinical trial. A total of 71 patients(71 eyes)of pterygium who treated at the department of ophthalmology in Qinhuangdao Haigang Hospital between May 2021 and November 2022 were included. They were divide into three groups, including 23 eyes received pterygium excision combined with ALSCT in group A, 24 eyes that were administered with 5-FU intraoperatively and postoperatively in group B, and 24 eyes that received both bandage contact lens and 5-FU in group C. Furthermore, comfort levels at 1, 3, 7, 14d postoperatively, corneal epithelial healing at 1, 3, 7, 14d and 1mo postoperatively, treatment outcomes and complications at 3~6mo postoperatively were compared among the three groups of patients.RESULTS:The comfort levels at 1, 3 and 7d postoperatively and corneal healing at 1 and 3d postoperatively of the group C were better than those of the groups A and B. There were no statistical significant differences in the comfort levels at 14d after surgery and corneal healing at 14d and 1mo after surgery among the three groups of patients. Over a 3~6mo follow-up period, group A experienced recurrence in 3 eyes, group B had 1 recurrence, while group C had no recurrence. There were no statistically significant differences in complication rates among the three groups of patients.CONCLUSIONS: The application of 5-FU combined with bandage contact lens can enhance postoperative comfort levels, promote corneal epithelial healing, and improve the success rate in pterygium excision combined with ALSCT.
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Background:Numerous surgical procedures and changes have been ineffective in preventing the recurrence of pterygium. Aprospective clinical observational analysis of 205 individuals with primary pterygium was conducted where patients were treated with various surgical procedures. The patients were observed for two to five years in order to examine the frequency of recurrences and consequences. Result: Patients were divided into four groups and treated using a variety of surgical methods. Straightforward excision of pterygium was the treatment of choice in group 1. Excision with conjunctival rotation pedicle graft was used on patients in Group 2. Excision and conjunctival autograft were used to treat Group 3 patients. Patients in Group 4 received excision and a 0.02 percent solution of mitomycin c drops as a postoperative treatment. Age varied from 22 to 58, with a median of 34. All four groups had an equal number of men and women. Hemorrhage, astigmatism, symblepheron, foreign body feeling, and a corneo-scleral ulcer were among complications that were reported. There were 12 percent complications in group 1, 16 percent complications in group 2, 6 percent complications in group 3, and 8 percent complications in group 4. Criteria for recurrence was defined as the regrowth of fibrovascular tissue or the appearance of an aesthetic flaw. It's 30 percent for group 1; 14 percent for group 2, 9 per cent for group 3, and 8 per cent for group 4. Conclusion: The least rate of recurrence was noted in patients of Group 4 who had pterygium excision with postoperative mitomycin c instillation, and complications were least common in patients in Group 3 who had pterygium resection with conjunctival autograft
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Background : Pterygium is a fibrovascular subconjunctival tissue also called Tenon’s Capsular growth occurring mostly in the palpebral fissure area from the nasal aspect towards the limbus over the Cornea and in this process the Corneal Pathology is changed especially the epithelium and bowman’s layer of the cornea are destroyed1. A major problem seen in most of postpterygium surgery is the complication of recurrence and it is usually seen in young patients with fleshy large pterygium1. This issue is addressed by Pterygium Surgery with either Conjunctival Autograft (CAG) or Amniotic Membrane Graft (AMG)1. Stem cells are present in limbal conjunctiva and in amniotic membrane, which provide a barrier between cornea and conjunctiva, preventing regrowth and also provide a smooth regular surface to the eyeball2. another reason and technique to prevent recurrence is by excising the pathological part of conjunctiva and resecting tenon’s capsule up to far periphery2. Aims and Objectives : The aim of the study is to investigate pre-operative and postoperative difference between the amount of astigmatism prior to the surgery and after the Pterygium Excision Surgery with either CAG or AMG. Materials and Method : A prospective cross-sectional study was undertaken of 26 cases, who underwent Pterygium Surgery under local anaesthesia with Conjunctival Autograft or Amniotic Membrane Graft for a period of one year in a Tertiary Healthcare Hospital. Pre-operative Best Corrected Visual Acuity, Anterior Segment Examination, Slit Lamp Examination, Dilated Retinoscopy and Fundus examination, Keratometry and Post mydriatic refraction was done. Then the patient underwent Pterygium Excision Surgery with Conjunctival Autograft or Amniotic Membrane Graft under local anaesthesia. All patients were re-examined 1 month after the surgery for final Refraction and Keratometry. Result : Among total of 26 patients, the comparison between pre- and postoperative values of Refraction and of Corneal Astigmatism was performed using z test. The pre-operative Mean for Astigmatism was 1.70 and SD was 0.43. The postoperative mean for Astigmatism was 0.57 and SD was 0.26. The pre-operative Keratometry mean was 2.73 and SD was 0.14. The Post operative Keratometry Mean was 1.50 and SD was 0.55. (p value, 0.0001) Conclusion: Pterygium is a lesion which also affects the ocular surface, thus leading to one of the causes for ocular surface abnormality. Pterygium surgeries results in elimination of the Pulling Factor and Corneal Curvature thus reducing or eliminating Astigmatism and thereby providing better visual restoration and cosmetic outcome
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Purpose: In this study, our aim was to investigate if fibrin adhesives used in conjunctival wound surgery with autologous conjunctival grafts could be used repeatedly at different times after surgical opening. Methods: 40 New Zealand rabbits were used in the study. These animals were divided into four groups, each consisting of 10 rabbits, and hence 20 eyes. In the first group (control group), Tisseel fibrin sealant was used on the day the eye was first opened surgically; in the second group, it was used on the seventh day; on the third group, it was used on the 14th day; and in the fourth group, it was used 28 days after surgical opening. The graft from the inferior bulbar conjunctiva was attached using Tisseel fibrin glue to the superior scleral bed at the location where the superior bulbar conjunctiva was excised in the same eye. Results: No microbial growth was detected in the cultures of the samples tested. There were two partial graft loss in group 2 and there was one partial graft loss in each group of the other groups, and further total graft loss was present in one rabbit in group 3. None of the rabbits had any complications like granuloma, Corneal dellen or infection. Conclusion: Based on these results, fibrin sealants can be used repeatedly by storing them at room temperature. Repeated use of fibrin adhesives will reduce the cost of ophthalmologic surgeries and non?ophthalmologic surgeries
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Context: p16 is an important tumor suppressor gene and responsible for regulating the cell cycle. Diffuse positivity with p16 in the cervix and head/neck carcinomas can be regarded as a surrogate marker of the presence of high-risk human papillomavirus (HPV). Aim: The aim of our study was to search the existence of p16 expression in pterygium. We also analyzed the association of p16 expression with epithelial dysplasia and HPV expression. Subjects and Methods: The study enrolled 75 cases of pterygium. The conjunctival tissues of 10 patients excised by the strabismus surgery were used as control group. All of the slides were stained with p16 via the immunohistochemical method. Results: 49 (65%) of pterygiums showed low-grade epithelial dysplasia. None of the control groups showed dysplasia. Positive expression of p16 in patient group was significantly higher (P < 0.001). Staining percentage (SP) of p16 was between 0 and 26% in pterygium; mean SP was 5.1%. There was no staining in the control group. A total of 59 (72%) pterygium cases were positive with p16. Appoximately 42 of 49 (85%) cases with dysplasia showed p16 staining. There was a significant relation between dysplasia and positive expression of p16 (P < 0.001). Conclusions: P16 is significantly expressed in pterygium and correlated with epithelial dysplasia. Furthermore, the existence of p16 expression suggests that HPV is a possible ethiological factor in pterygium. We think that examination of p16 expression and analysis of HPV DNA in p16 positive cases can help us to understand the etiopathogenesis of the disease better.