Introduction: High recurrence of a fibrotic disease, pterygium, following the surgical procedure is perceived as the primary challenge of its management. As the standard procedure, adjuvant therapy of using mitomycin C could dramatically reduce the recurrence of pterygium but could cause multiple serious complications. Our study aimed to investigate curcumin and fibrin glue as alternative candidates for adjuvant therapy in pterygium surgery. Methods: Human pterygium fibroblast (HPF) was isolated from the patient and cultured in-vitro. The HPF culture was then exposed with mitomycin C (0.4 mg/mL), curcumin (200 μmol/L), and fibrin glue, respectively, for 48 hours. The outcomes were determined by the proliferation of HPF and the expression of transforming growth factor-beta (TGF-β) which were obtained from 2,5-diphenyl-2H-tetrazolium bromide assay and immunofluorescence staining analysis with TGF-β antibody. Results: The experiment revealed that mitomycin C, curcumin, and fibrin glue could significantly inhibit the proliferation of HPF (p<0.05) suggesting their antifibrotic effect. Further analysis with immunofluorescence staining showed that mitomycin C, curcumin, and fibrin glue could significantly reduce the level of TGF-β as compared with control group (p<0.05). Conclusion: Mitomycin C was the most potent adjuvant agent to reduce the recurrence of pterygium, followed by curcumin and fibrin glue. Taken altogether, curcumin and fibrin glue have role as adjuvant therapy to prevent recurrence in pterygium surgery.
Pterygium is a wing-shaped growth from the conjunctiva and fibrovascular tissue onto the surface of the cornea. It has a high postoperative recurrence rate (which can be as high as 89% and its severity may vary according to the approach adopted and the preoperative conditions). To reduce the postoperative recurrence rate, several surgical techniques have been developed. The pathophysiology of pterygium development is diverse, one of the main factors is the proliferative process initiated by the TGF-mediator. One of the therapies developed to prevent pterygium recurrence is by targeting therapy on the proliferative pathway by adding pterygium surgery with adjuvant MMC therapy. MMC plays a role in inhibiting DNA synthesis, thereby reducing TGF-expression and ultimately inhibiting cell proliferation. Although it can reduce the recurrence rate quite well, MMC has numbers of complications. Therefore, an agent is needed to suppress pterygium proliferation which is relatively safer. Curcumin is a compound derived from the tuber of Curcuma longa L. which includes polyphenols. Curcumin modulates proliferation by stimulating the formation of TGIF which is a negative regulator of TGF-so that it can modulate proliferation.
Purpose: To report a management of challenging case of phacoemulsification in cataract with subluxated lens. Methods: A 63 male patient referred to RSDS with secondary lens induced glaucoma and cataract with subluxation around 210O on left eye. Patient was planned to undergone Phacoemulsification with combination of CTR and Iris Hook for lens extraction. Result: Postoperative result is satisfactory with minimal corneal edema. After 6 weeks of follow-up uncorrected vision is 5/8 with correction of S+0.25 became 5/5 and IOP is stable at 17 mmHg and the IOL was in placed in the bag and well centered. Conclusion: Phacoemulsification with iris hooks combined with CTR is one of surgery option that is safe and widely attainable for cataract with subluxated lens.
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