Pterygium: an update on pathophysiology, clinical features, and management

Abstract

Pterygium is a relatively common ocular surface disease. The clinical aspects and the treatment options have been studied since many years ago, but many uncertainties still exist. The core pathologic pathway and the role of heredity in the development of pterygium are still attractive fields for the researchers. The role of pterygium in corneal irregularities, in addition to the refractive properties of pterygium removal, has been increasingly recognized through numerous studies. The association between pterygium and ocular surface neoplasia is challenging the traditional beliefs regarding the safe profile of the disease. The need for a comprehensive clinical classification system has encouraged homogenization of trials and prediction of the recurrence rate of the pterygium following surgical removal. Evolving surgical methods have been associated with some complications, whose diagnosis and management are necessary for ophthalmic surgeons. According to the review, the main risk factor of pterygium progression remains to be the ultraviolet exposure. A major part of the clinical evaluation should consist of differentiating between typical and atypical pterygia, where the latter may be associated with the risk of ocular surface neoplasia. The effect of pterygium on astigmatism and the aberrations of the cornea may evoke the need for an early removal with a purpose of reducing secondary refractive error. Among the surgical methods, conjunctival or conjunctival-limbal autografting seems to be the first choice for ophthalmic surgeons because the recurrence rate following the procedure has been reported to be lower, compared with other procedures. The use of adjuvant options is supported in the literature, where intraoperative and postoperative mitomycin C has been the adjuvant treatment of choice. The efficacy and safety of anti–vascular endothelial growth factor agents and cyclosporine have been postulated; however, their exact role in the treatment of the pterygium requires further studies.

Transcriptome Analysis of Pterygium and Pinguecula Reveals Evidence of Genomic Instability Associated with Chronic Inflammation

“…Analysis of the genomes of thousands of human cancers has revealed that TP53 is inactivated by mutation in over 50% of sporadic human tumors [ 104 ]. At one time, the main pathway for development of pterygium was believed to be mutations in TP53 [ 105 ]. However, this hypothesis has fallen out of favor for a variety of reasons, an important one being that inactivating TP53 mutations could not be detected [ 106 , 107 , 108 ].…”

Corneal Epithelial Stem Cells–Physiology, Pathophysiology and Therapeutic Options

“…Two limbal grafts from the 6 and 12 o’clock positions of the healthy contralateral eye are harvested, transplanted and secured to the diseased eye [ 14 ]. The most common use of CLAU has been performed in surgery for pterygium or severe corneal chemical burn [ 216 , 217 ]. In recent years, several studies have reported the long-term ocular surface stability of CLAU in unilateral LSCD [ 218 ].…”

Pseudomonas aeruginosa Scleritis following Pterygium Surgery with Mitomycin C or Beta Irradiation: Three-Case Report

“…Thus, pterygium excision is one of the most common ophthalmic operations in patients who live in tropics and subtropics [ 2 ]. The bare sclera technique is the first surgical intervention associated with high rates of pterygium recurrence and postoperative infection [ 8 ]. Pseudomonas aeruginosa scleritis is commonly associated with the excision of pterygium and may occur years after surgery.…”