Systematic Review: Effects of Pterygium and Pingueculum on the Ocular Surface and Efficacy of Surgical Excision

Abstract

Purpose: This systematic review examines the specific effects of pingueculum and pterygium on the ocular surface and evaluates the efficacy of surgical excision in reversing those effects. Methods: A systematic review was performed according to the Preferred Reporting Items for the Systematic Review and Meta-Analyses statement and included 59 articles studying the effects of pterygium and pingueculum on the ocular surface as measured by tear break-up time (TBUT), Schirmer testing, tear osmolarity, Ocular Surface Disease Index (OSDI), and the effects of surgical removal on these ocular surface parameters. Results: In most studies, eyes with pterygium or pingueculum when compared with control eyes had a statistically significantly lower TBUT (average 3.72 s), lower Schirmer I without anesthesia (average 3.01 mm), lower Schirmer II (average 4.10 mm), higher tear osmolarity (average 12.33 mOsm/L), and higher OSDI (average 6.82 points). Moreover, excision of pterygium and pingueculum led to a statistically significantly higher TBUT (average 3.15 s higher at 1 mo postexcision), lower tear osmolarity (average 3.10 mOsm/L lower at 3 mo postexcision), and lower OSDI score (average 2.86 points lower 1 mo postexcision) in most of the studies. The effect of excision on Schirmer test scores was equivocal because most studies did not reach significance. Conclusions: Our data confirm the relationship between pterygium and pingueculum and abnormal tear function and symptoms of dry eye disease. Furthermore, the data suggest that tear film parameters might improve after surgical removal of pterygium or pingueculum. Future studies would be helpful in exploring the potential role of pterygium and pingueculum excision in the management of dry eye disease.

Management of Primary Pterygium with Intralesional Bevacizumab (AVASTIN) Injection

“…12,13 Anti VEGF therapy causes the regression of blood vessels & prevents angiogenesis leading to a decrease in the size of Pterygium. 14,15 Although Pterygium has unclear pathogenesis, one of the important factors in its formation and progression is neovascularization. It has been proposed that a change in the ratio of an angiogenic stimulator to an inhibitor determines their development.…”

Tear Film Stability After Primary Pterygium Excision Combined with Limbal Stem Cell Transplantation is Superior to Amniotic Membrane Transplantation: A Meta-Analysis

“…Of course, AMT also has its advantages, which can be bene cial in patients with ocular surface reconstruction, such as extensive conjunctival scarring and chemical injury or those who may require future glaucoma surgery [1,10]. A previous study showed that regardless of the surgical approach, the tear lm stability of patients after pterygium surgery is improved to varying degrees [13]. However, because the degree of tear lm stability improvement by the above two transplant means still showed con icting results [14][15][16][17][18][19][20], we conducted this meta-analysis to provide a more robust and accurate estimate of our study.…”

“…Patients with pterygium have disturbances in tear quality, quantity, and reduction of conjunctival goblet cell population [3]. One study showed that excision of pterygium could lead to an improved tear lm stability [13]. The main objective of this summary of our review is to report the comparison of tear lm stability after primary pterygium excision combined with LSCT or AMT based on the best available evidence.…”

The unique properties of tear film breakup process in patients with nasal unilateral pterygium

“…1 Dry eye disease has been shown to be an important risk factor of pterygium development due to the increased tear osmolarity and chronic ocular surface inflammation. [2][3][4][5] The alternation of ocular surface-related parameters in pterygium has been extensively studied in recent years. The normal secretion of tears in eyes with pterygium revealed that the mechanism of its tear film instability was completely different from that of aqueous tear-deficient dry eye.…”

“…The normal secretion of tears in eyes with pterygium revealed that the mechanism of its tear film instability was completely different from that of aqueous tear-deficient dry eye. [2][3][4][5] The similarities in incidence, gene signature, and severity between pterygium and meibomian gland dysfunction suggested that the reduced lipid layer thickness in pterygium may be a possible mechanism for tear film instability. 3,[5][6][7] However, a majority of previous studies have used control groups from the normal population.…”