Treatment of pterygia in Queensland

All practising ophthalmologists in Queensland completed a written survey on their current methods of treatment of pterygia. The indications for surgical removal, in decreasing order of importance, were mainly size, symptomatic complaints, cosmetic appearance and activity. Most surgeons graded pterygia into a variety of classifications. The most common form of treatment for primary pterygia was simple excision plus mobilisation of conjunctiva and suturing conjunctival free edges together followed by bare sclera technique, and simple excision plus thiotepa drops. For recurrent pterygia simple excision plus beta-irradiation was the most common form of treatment, followed by simple excision plus thiotepa drops and simple excision plus mobilisation of conjunctiva and suturing conjunctival free edges together. A third of the ophthalmologists electively avoid cautery use during pterygium surgery, while almost a quarter of the ophthalmologists attempt to polish the corneal and limbal region. When beta-radiation or Thiotepa is used there is a general consensus on the dosage for each of these. Seventeen per cent of ophthalmologists said they had not encountered any complications after pterygium surgery with the remainder quoting corneoscleral necrosis from beta-radiation and Tenon's granuloma as the most common complications. It would appear that there is no consensus on the best way to treat pterygia in Queensland, which probably reflects the lack of scientific proof for one method being superior to another.     

The association between pterygium and conjunctival ultraviolet autofluorescence: The Norfolk Island Eye Study

Purpose: To investigate the association between conjunctival ultraviolet autofluorescence (UVAF), a biomarker of ocular ultraviolet radiation (UVR) exposure, and prevalent pterygium. Methods: We conducted a cross‐sectional study on Norfolk Island, South Pacific. All permanent residents aged ≥15 were invited to participate. Participants completed a sun exposure questionnaire and underwent autorefraction and slit lamp biomicroscope examination. Area of conjunctival UVAF (sum of temporal/nasal area in right and left eyes) was determined using computerized methods. Multivariate logistic and linear regression models were used to estimate the associations with pterygia and UVAF, respectively. Results: Of 641 participants, 70 people (10.9%) had pterygium in one or both eyes, and prevalence was higher in males (15.0% versus 7.7%, p = 0.003). Significant independent associations with pterygium in any eye were UVAF (per 10 mm²) [odds ratio (OR) 1.16, 95% confidence interval (CI) 1.16–1.28, p = 0.002], tanning skin phenotype (OR 2.17, 1.20–3.92, p = 0.010) and spending more than three‐quarters of the day outside (OR 2.22, 1.20–4.09, p = 0.011). Increasing quartile of UVAF was associated with increased risk of pterygium following adjustment of age, sex and time outdoors (p_Trend = 0.002). Independent associations with increasing UVAF (per 10 mm²) were decreasing age, time outdoors, skin type and male gender (all p < 0.001). UVAF area correlated well with the duration of outdoor activity (p_Trend < 0.001). Conclusion: Pterygium occurs in approximately one‐tenth of Norfolk Islanders. Increasing conjunctival UVAF is associated with prevalent pterygia, confirming earlier epidemiological, laboratory and ray‐tracing studies that pterygia are associated with UVR. Protection from the sun should be encouraged to reduce the prevalence of pterygium in the community.     

翼状胬肉发病机制及治疗研究进展

翼状胬肉的发病机制有多种不同的解释。目前尚无一种公认经典的发病机制理论。临床治疗效果也不是人意，复发率较高。通过查阅近年来国内外有关该疾病发病机制及治疗方面的较新文献，对该疾病的发病机制及治疗作一综述，以期能对该疾病研究情况有一较全面报解。为今后研究翼状胬肉瓜子放治疗奠定基础。     

翼状胬肉切除术后角膜地形图改变

目的 探讨翼状胬肉术后角膜地形图的改变。方法 对40例(40眼)翼状胬肉行手术切除,分别于术前、术后使用角膜地形图仪进行检测,记录术前、术后角膜地形图主要参数、最佳矫正视力,并进行统计学分析。结果 角膜地形图参数:平均地形图散光术前(5.08±2.75)D,术后(3.33±2.38)D;平均中央角膜球形屈光度术前(42.94±2.64)D,术后(44.08±3.00)D;平均角膜地理中心与视轴中心距离术前(1.31±1.00)mm,术后(0.70±0.69)mm;平均角膜表面形态系数SF术前(0.47±0.21),术后(0.38±0.18);平均角膜表面不规则指数CIM术前(3.34±1.24),术后(2.03±1.31),上述参数术前与术后,差异有显著意义(P<0.05)。平均最佳矫正视力术前(0.50±0.35),术后(0.66±0.34)二者差异有显著意义(P<0.05)。结论 翼状胬肉切除术能明显改善术前角膜地形图的不规则形态,有利于提高视力和视觉质量。     

翼状胬肉切除术后角膜地形图及散光度的改变

目的探讨翼状胬肉切除术后角膜地形图及散光度的改变。方法对56例（56眼）翼状胬肉行手术切除,分别于术前、术后使用角膜地形图仪进行检测,记录术前、术后第3个月的角膜地形图主要参数、最佳矫正视力,术前和术后以角膜地形图及综合验光仪验光法确定角膜散光情况,并进行统计学分析。结果角膜地形图检查平均散光：术前为（5.14±3.12）D,术后为（3.19±2.44）D,术后散光较术前减少,差异具有非常显著的统计学意义（P〈0.01）。综合验光仪验光平均散光：术前（1.91±0.64）D,术后（1.12±0.71）D,术后较术前亦有所减少,差异具有统计学意义（P〈0.05）。角膜地形图参数：平均中央角膜曲率术前（42.94±3.13）D,术后（44.72±2.94）D;平均角膜几何中心与视轴中心距离术前（1.17±1.26）mm,术后（0.64±0.41）mm;平均角膜表面形态系数SF术前0.53±0.17,术后0.31±0.14;平均角膜表面不规则指数CIM术前3.29±1.35,术后2.01±1.04;上述参数术前与术后比较,差异均有统计学意义（P〈0.05）。平均最佳矫正视力 ：术前4.73±0.31,术后4.92±0.29,两者差异有统计学意义（P〈0.05）。结论翼状胬肉切除术能明显减少角膜散光,改善术前角膜地形图的不规则形态,有利于提高视力和视觉质量。     

Occurrence of human papillomavirus in pterygia

Purpose: The aim of the study was to assess the occurrence of human papillomavirus (HPV) DNA in pterygium. Methods: The study involved 89 patients undergoing surgical procedures at the Department of Ophthalmology, Medical University of Lublin, Poland. Group 1 included 58 patients with clinically diagnosed pterygium. Group 2 consisted of 31 individuals with normal conjunctiva. The material was collected during elective surgical procedures. The presence of HPV genome was determined using polymerase chain reaction (PCR). Once the presence of HPV DNA was confirmed, 28 HPV genotypes were determined using reverse hybridization. Results: The determinations confirmed the presence of HPV DNA in pterygium. In the material collected from 58 cases of pterygium (group 1), HPV DNA was identified in 16 patients (27.6%). In the material from 31 diagnostic specimens of normal conjunctiva (group 2), the presence of HPV was demonstrated in three cases (9.7%). A statistically significant difference was found in the presence of HPV DNA between the patients from groups 1 and 2 (p = 0.041). HPV type 16 was most common and was demonstrated in 56% of HPV‐positive cases of pterygium. HPV 16 and HPV 6 co‐infections were found in 19% of cases, while HPV 18 and HPV 6 co‐infections were observed in 13%. In group 2, all three patients with HPV showed HPV 18. Conclusion: It seems that HPV is not necessary to induce pterygium; however, it might play a synergistic role in the multi‐stage process of its development.     

5-氟尿嘧啶治疗人羊膜移植后翼状胬肉复发的临床研究

目的观察5-氟尿嘧啶用于人羊膜移植后复发性翼状胬肉治疗的临床疗效。方法362例379眼翼状胬肉患者行翼状胬肉切除术联合羊膜移植术,其中初发性翼状胬肉例346眼,复发性翼状胬肉33眼。术后36例复发,复发率9%。对复发病例采用5-氟尿嘧啶结膜下注射,定期随访观察。结果36例复发病例5-氟尿嘧啶注射后,随访6～24月,痊愈加显效24例(有效率67%),9例有效(25%),3例无效。2例发生穹窿缩短,1例接受自体角膜干细胞移植加羊膜移植治愈。7例5-氟尿嘧啶注射后多发性角膜上皮点状脱落,停药后6例24～48小时愈合,1例点用表皮生长因子1周后痊愈。结论5-氟尿嘧啶结膜下注射是治疗羊膜移植后复发性翼状胬肉一种安全、简便、有效的方法。     

EphrinB2 and EphB4 expression in pterygia: new insights and preliminary results

Objective: Pterygium is a growth of fibrovascular tissue onto the cornea, in which the mechanisms of cell proliferation and vascularization are unknown. The ephrin-Eph system, especially ephrinB2 and its receptor EphB4, has been shown to play an important role in tumor angiogenesis. EphrinB2 and EphB4 have also been reportedly involved in the pathogenesis of ocular angiogenesis. This study was designed to investigate the expression of ephrinB2 and its receptor EphB4 in pterygia.Design: Experimental study of the expression of ephrinB2 and its receptor EphB4 in pterygia.Participants: Twenty-three primary pterygia, 5 recurrent pterygia, and 11 normal conjunctiva were studied.Methods: Immunohistochemistry studies were used to assess ephrinB2 and EphB4 protein expression levels and the tissue distribution in the samples.Results: EphrinB2 and EphB4 staining was present at a dense level in the total epithelium of the head portions of both primary and recurrent pterygial specimens, although just in the basal and parabasal layer of the epithelium of most of the normal conjunctivae.Conclusions: EphrinB2 and EphB4 appear to be overexpressed in pterygium, and they may play important roles in its development.     

Pterygium surgery by double-sliding flaps procedure: Comparison between primary and recurrent pterygia

Purpose:This study aimed to evaluate the surgical outcomes of pterygial excision for primary and recurrent pterygia by a single method of pterygia excision combined with two conjunctival flaps.Methods:This retrospective study divided 193 cases of pterygium into the primary (140 cases) and recurrent (53 cases) pterygium groups. Following double-sliding conjunctival transposition flap operation and surgical excision of the pterygium, the success and recurrence rates of pterygial surgery were assessed based on visual acuity and corneal and total astigmatism during follow-up at least 6 months.Results:Both primary and recurrent pterygium groups showed significant improvements in visual acuity and astigmatism (corneal and total) between before and after this procedure. Total astigmatism and success rate of primary pterygium were significantly better than those for recurrent pterygium. Two cases (1.4%) of primary pterygium and four cases (7.5%) of recurrent pterygium developed recurrence, corresponding to a rate of 3.1% (6/193 cases). The success rates significantly make a difference between primary and recurrent groups but did not differ significantly between the first recurrent and over twice recurrent pterygium. However, visual acuity, cornea, and total astigmatism improved significantly after surgery in first recurrent group but not in over twice recurrent group.Conclusion:The double-sliding conjunctival flaps surgery appeared to be a useful method, with a better success rate and lower pterygial recurrence in pterygium surgery. Especially, when pterygium is larger or recurrent type, this technique can be easily covered the bare sclera, as compared to any transposition conjunctival flap operation.     

Distribution of conjunctival ultraviolet autofluorescence in a population-based study: the Norfolk Island Eye Study

Objective

The objective of this study was to describe the distribution of conjunctival ultraviolet autofluorescence (UVAF) in an adult population.

Methods

We conducted a cross-sectional, population-based study in the genetic isolate of Norfolk Island, South Pacific Ocean. In all, 641 people, aged 15 to 89 years, were recruited. UVAF and standard (control) photographs were taken of the nasal and temporal interpalpebral regions bilaterally. Differences between the groups for non-normally distributed continuous variables were assessed using the Wilcoxon–Mann–Whitney ranksum test. Trends across categories were assessed using Cuzick''s non-parametric test for trend or Kendall''s rank correlation τ.

Results

Conjunctival UVAF is a non-parametric trait with a positively skewed distribution. Median amount of conjunctival UVAF per person (sum of four measurements; right nasal/temporal and left nasal/temporal) was 28.2 mm² (interquartile range 14.5–48.2). There was an inverse, linear relationship between UVAF and advancing age (P<0.001). Males had a higher sum of UVAF compared with females (34.4 mm² vs23.2 mm², P<0.0001). There were no statistically significant differences in area of UVAF between right and left eyes or between nasal and temporal regions.

Conclusion

We have provided the first quantifiable estimates of conjunctival UVAF in an adult population. Further data are required to provide information about the natural history of UVAF and to characterise other potential disease associations with UVAF. UVR protective strategies should be emphasised at an early age to prevent the long-term adverse effects on health associated with excess UVR.     

PEDF和VEGF在翼状胬肉组织中的不平衡表达

目的 检测翼状胬肉组织中血管生长因子VEGF、FGF-2和抑制因子PEDF的表达，以研究PEDF在翼状胬肉发展中所起作用。方法 用免疫荧光组化法及免疫印迹法对9例原发性翼状胬肉组织进行PEDF、VEGF及FGF-2的检测、分析，并与8例正常人结膜、角膜组织进行对照研究。结果 PEDF在正常人结膜、角膜上皮中高表达，而在翼状胬肉组织中没有或弱表达。VEGF和FGF-2在翼状胬肉组织中高表达，而在正常人结膜、角膜组织中表达较弱。结论 在翼状胬肉组织中血管生长抑制因子PEDF没有或弱表达，而血管生长因子VEGF和FGF-2高表达，提示两者不平衡表达引起纤维血管增生。     

翼状胬肉组织PEDF和VEGF的不平衡表达

目的检测翼状胬肉组织中血管生长因子VEGF、FGF-2和抑制因子PEDF的表达,以研究PEDF在翼状胬肉发展中所起作用。方法用免疫荧光组化法对9例原发性翼状胬肉组织进行PEDF、VEGF及FGF-2的检测,并与8例正常人结膜组织进行对照研究。结果PEDF在正常人结膜、角膜上皮中高表达,而在翼状胬肉组织中没有表达。VEGF和FGF-2在翼状胬肉组织中高表达,而在正常人结膜、角膜组织中表达较弱。结论在翼状胬肉组织中血管生长抑制因子PEDF没有表达,而血管生长因子VEGF和FGF-2高表达,提示两者不平衡引起纤维血管增殖。     

明胶酶A及血管内皮细胞生长因子在翼状胬肉组织中的表达

目的探讨血管内皮细胞生长因子(vascularendothelialgrowthfactor,VEGF)、明胶酶A与翼状胬肉发生、浸润的关系。方法术中切除的31例翼状胬肉标本制成冰冻切片,经免疫组织化学方法检测翼状胬肉组织中VEGF、明胶酶A的表达,并与正常结膜组织中VEGF、明胶酶A的表达对比,以半定量分法评价并统计其结果。结果正常结膜组织与翼状胬肉上皮组织VEGF表达阴性、弱阳性、强阳性例数分别为6、2、0和0、8、23(χ2=29.187),明胶酶A表达阴性、弱阳性、强阳性例数分别为8、0、0和0、8、23(χ2=39·00),差异都有极显著意义(P<0.001)。静止期与进展期翼状胬肉上皮组织VEGF表达弱阳性、强阳性例数分别为4、19和4、4(χ2=4.216,P<0.05),明胶酶A表达弱阳性、强阳性例数分别为2、21和6、2(χ2=12.816,P<0.001),差异有显著意义。结论VEGF、明胶酶A在翼状胬肉组织中过度表达,其表达量与翼状胬肉的病理分期密切相关,提示二者在翼状胬肉的形成和浸润过程中起重要作用。     

Nutrient patterns and risk of cataract: a case-control study

AIM: To assess the relation between nutrient patterns and cataract risk. METHODS: This is a hospital-based case-control study with 97 cataract patients and 198 matched controls. Dietary consumption was collected through a valid food frequency questionnaire (FFQ). Nutrient patterns were detected by applying factor analysis. Unconditional logistic regression models were used to estimate odds ratio (ORs) and 95%CIs. RESULTS: We extracted 5 main nutrient patterns. Factor 1 included niacin, thiamin, carbohydrates, protein, zinc, vitamin B6 and sodium (sodium pattern). Factor 2 was characterized by oleic acid, monounsaturated fats, polyunsaturated fats, linoleic acid, trans fatty acid, linolenic acid, vitamin E and saturated fats (fatty acid pattern). The third factor represented high intake of vitamin B12, vitamin D, cholesterol and calcium (mixed pattern). The 4th pattern was high in intake of beta and alpha carotene, vitamin A and vitamin C (antioxidant pattern). Finally, the 5th pattern loaded heavily on docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) (omega-3 pattern). In crude and multivariate analysis, the sodium pattern was associated with increased risk of cataract (OR=1.97, 95%CI: 1.09-3.96). The fatty acid pattern elevated the risk of cataract (OR=1.94, 95%CI: 1.1-3.86). Antioxidant pattern was associated with a significant 79% reduced risk (2nd category compared with the 1st). Omega-3 pattern was significantly negatively associated with risk of cataract (P=0.04). CONCLUSION: These findings imply that nutrient patterns reflecting a combined consumption of nutrients might be important in the etiology of cataract. Additional studies with more efficient designs are warranted to confirm our findings.     

Senile macular degeneration and risk factors: a case-control study

A case-control study of patients ranging in age from 52 to 88 years was done to determine any possible relationship between health factors and senile macular degeneration. Thirty cases and 30 controls were pair-matched according to age, sex, and race. Chart reviews and telephone interviews were the methods of data collection used. The patients were interviewed concerning a history of vascular disease and other health characteristics. The data were analyzed by a paired-sample method. The results of the study showed a definite relationship with age and sex. Moreover, a significant relationship between refractive error and senile macular degeneration was noted. Such an association has not been previously reported. No relationship was found between vascular disease and senile macular degeneration.     

安徽省凤台县翼状胬肉患病情况调查

目的　了解凤台县翼状胬肉的患病情况。方法　采取分层、整群、随机抽样的方法 ,对凤台县 10 1973人进行了翼状胬肉流行病学调查。结果　翼状胬肉的患病率为2 .73% .渔民、农民分别为 4.43%和 2 .80 % ,并且患病率有随年龄增长而增高的趋势 ,与遗传有关的为 41.2 0 % .结论　翼状胬肉的患病率高低 ,与年龄、地理位置、气候、职业、遗传因素等有关