Pterygium: etiology, pathogenesis, treatment

Abstract

Pterygium is a degenerative condition characterized by fibrovascular outgrowth of conjunctiva over the cornea. Many theories exist that try to explain its pathogenesis. The current belief is that this disease is multifactorial with ultraviolet radiation being the most important trigger. Attention is also paid to such factors as tear film changes, cytokines and growth factors disbalance, immunologic disturbances, genetic mutations, and viral infections. Modern classifications consider the rate of fibrovascular growth, its progressive potential, and histological features. In the beginning pterygium is usually asymptomatic, however, dry eye manifestations may be present, such as burning, itching, and/or tearing. As the lesion grows toward the optical zone, visual acuity gets compromised, and thus, surgical treatment is required. Because of recurrences and repeated surgeries, the growth of the lesion may become more aggressive and cause irregular astigmatism. Comprehensive surgery of pterygium is aimed at not only removing the lesion, but also preventing recurrences. Advisable are modified bare sclera techniques with subsequent transposition of the conjunctival flap, conjunctival autotransplantation, amniotic membrane transplantation, and peripheral lamellar keratoplasty (in cases of significant ingrowth). In some cases, antirecurrent adjuvant therapy may be considered that involves the use of mitomycin C, 5-fluoruracil, and VEGF inhibitors. However, the search for the best treatment for pterygium, i.e. an easy to perform, cosmetically-friendly method associated with minimal risk of recurrences and/or complications, remains an interest of modern ophthalmology.

Identification and Interaction Analysis of Significant Genes and MicroRNAs in Pterygium

“…Doxycycline has been a successful adjunctive treatment for pterygium, because of its significant inhibition of angiogenesis [56, 57]. Mitomycin C, considered in antirecurrent adjuvant therapy in some case to inhibit the cellular proliferation and migration, could be used in pterygium [58, 59], but because of the possibility of serious late complications, it always reserved for patients who had high probability of recurrence after excision of pterygium [60, 61]. However, their roles in the treatment of pterygium might have some limitations in application and require further investigation.…”

Protective Role of Glutathione and Nitric Oxide Production in the Pathogenesis of Pterygium

“…Surgery is the principal treatment, leading in some cases to recurrence. e mechanisms of pathogenesis have been discussed in several reviews [1][2][3]. e key factor in the etiology of pterygium is considered to be chronic exposure to UV radiation [4,5], resulting in oxidative stress.…”

Protective Role Of Glutathione And Role Of Nitric Oxide Production In The Pathogenesis Of Pterygium 

“…Surgery is the principal treatment, leading in some cases to recurrence. The mechanisms of pathogenesis have been discussed in several reviews [1][2][3]. The key factor in the etiology of pterygium is considered to be chronic exposure to UV radiation [4,5], resulting in oxidative stress.…”