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This study aims to determine whether morphological features of pterygium are linked to clinical parameters of dry eye disease. We examined 122 eyes from 109 patients with primary nasal pterygium who underwent preoperative anterior segment swept-source optical coherence tomography (AS SS-OCT, Anterion ® , Heidelberg Engineering, Germany) and evaluated dry eye parameters, including the clinical severities of meibomian gland dysfunction, tear osmolarity, Schirmer I, tear matrix metalloproteinase-9 expression, and ocular surface staining. Morphological profiles of pterygium based on AS SS-OCT included horizontal invasion length (HIL), pterygium height, pterygium thickness, and the ratio of residual corneal thickness (RCT) to central corneal thickness (CCT). AS SS-OCT-guided values of anterior corneal astigmatism (ACA) and root mean square (RMS) values of lower-order aberrations (LoA) and higher-order aberrations (HoA) were also obtained. HIL was negatively correlated with corneal erosions and the Sjögren’s International Collaborative Clinical Alliance ocular staining score (SICCA OSS). Pterygium height and thickness were positively correlated with tear osmolarity, Schirmer I, and SICCA OSS. Additionally, ACA, corneal RMS LoA and HoA were negatively correlated with corneal erosions and SICCA OSS. Given that HIL inversely correlated with pterygium height and thickness, early pterygium appears to induce desiccation, pterygium surface erosions, and increased reflex lacrimation.

AimsTo investigate the role of high-resolution anterior segment optical coherence tomography (HR-ASOCT) in the assessment of pterygia.MethodsSingle centre cross-sectional study. Patients with primary pterygium and/or pingueculae were included. Clinical assessment included HR-ASOCT, colour photography, keratometry followed by histology. Associations were tested between HR-ASOCT features of the pterygium and the degree of corneal scarring and elastotic degeneration, astigmatism and best-corrected visual acuity.Results29 eyes of 26 patients with pterygium and 6 patients with pinguecula were included. Apical anterior stromal scarring was found in 23 cases (79.3%) reaching a mean depth of 68.8±21.7 µm (minimum: 33 µm, maximum: 126 µm). Increased stromal scarring and subepithelial elastotic degenerative tissue was significantly associated with HR-ASOCT features of flat bridging of the corneoscleral transition zone (p<0.01) reduced thickness of the pterygium head (p=0.01), and a greater degree of corneal astigmatism (p=0.04).ConclusionsHR-ASOCT is a useful tool for the assessment and monitoring of pterygia in clinical practice. Features associated with increased stromal scarring and astigmatism are reduced thickness of the head of the pterygium and flat bridging of the corneoscleral transition zone.

Pterygium morphology had great effect on corneal astigmatism and intraocular lens (IOL) power calculation in cataract patients. However, previous studies all focused on the pterygium surface parameters, the invasion degree or cross-sectional area of the pterygia into the corneal stroma were neglected. We studied the effect of three-dimensional parameters of pterygium on corneal astigmatism and IOL power prediction. We enrolled 81 eyes of 81 patients with primary nasal pterygium, measured the corneal astigmatism (Pentacam HR) and predicted IOL power change (IOLmaster500) before and after pterygium surgery. The three-dimensional parameters of pterygium (length, width, area, height and invasion cross-sectional area) were measured by slit lamp photography and Scheimpflug images. After pterygium surgery, corneal astigmatism decreased from 4.35 ± 4.24 to 1.07 ± 0.95 D and total corneal refractive power increased from 43.02 ± 1.96 to 43.95 ± 0.95 D (both P < 0.001). The predicted IOL power decreased from 22.87 ± 2.82 to 21.71 ± 2.85 D (P < 0.001) after surgery. Notably, 34 eyes (41.98%) had ≥3.0 D of pterygium induced astigmatism (PIA), and 33 eyes (40.74%) had ≥1.0 D of predicted IOL power change. PIA was independently influenced by the pterygium surface area (r = 0.43, P < 0.001) and cross-sectional area (r = 1.25, P = 0.018), while the predicted IOL power change was independently affected by the pterygium width (r = 0.70, P < 0.001). Cataract surgeons could evaluate the effects of a pterygium according to its three-dimensional parameters and prepare an optimal surgical strategy for cataract combined pterygium patients.

BackgroundGermline mutations in the CHRNG gene that encodes the γ subunit of the embryonal acetylcholine receptor may cause the non-lethal Escobar variant (EVMPS) or the lethal form (LMPS) of multiple pterygium syndrome (MPS). In addition CHRNG mutations and mutations in other components of the embryonal acetylcholine receptor may present with fetal akinesia deformation sequence (FADS) without pterygia.MethodsIn order to elucidate further the role of CHRNG mutations in MPS/FADS, this study evaluated the results of CHRNG mutation analysis in 100 families with a clinical diagnosis of MPS/FADS.ResultsCHRNG mutations were identified in 11/41 (27%) of families with EVMPS and 5/59 (8%) with LMPS/FADS. Most patients with a detectable CHRNG mutation (21 of 24 (87.5%)) had pterygia but no CHRNG mutations were detected in the presence of central nervous system anomalies.DiscussionThe mutation spectrum was similar in EVMPS and LMPS/FADS kindreds and EVMPS and LMPS phenotypes were observed in different families with the same CHRNG mutation. Despite this intrafamilial variability, it is estimated that there is a 95% chance that a subsequent sibling will have the same MPS phenotype (EVMPS or LMPS) as the proband (though concordance is less for more distant relatives). Based on these findings, a molecular genetic diagnostic pathway for the investigation of MPS/FADS is proposed.

AIMS To characterise the vasculature of pterygium using indocyanine green (ICG) anterior segment angiography and to demonstrate the pattern of revascularisation following conjunctival autografting. METHODS ICG anterior segment angiography was performed on nine patients with pterygium. Angiography was repeated at 1–2 weeks and 2 months following conjunctival autografting in these patients. RESULTS Angiography showed a single feeder vessel originating from the anterior conjunctival circulation in six cases (66.7%). This vessel branched to form the radial vessels of the pterygium. Following conjunctival autografting, reperfusion of the vessels in the conjunctival autograft was demonstrable as early as 1 week postoperatively from the episcleral bed. At 2 months postoperatively, the graft appeared well perfused with mild leakage demonstrable at the edges of the graft. CONCLUSIONS A single feeder vessel from the anterior conjunctival circulation branches to form the radial vessels in pterygium. Reperfusion of conjunctival autografts occurs as early as 1 week postoperatively from the episcleral bed.

This study aimed to report corneal steep island (CSI) formation following primary pterygium surgery and to identify preoperative pterygium morphological features that predict the likelihood of CSI. A total of 93 eyes from 84 subjects with primary nasal pterygium, who underwent pterygium excision combined with conjunctival-limbal autograft, were included in this retrospective longitudinal cohort study. CSI was defined using anterior segment swept-source optical coherence tomography (AS SS-OCT). Eyes were divided into two groups: those with postoperative CSI formation (Group 1) and those without postoperative CSI (Group 2). We compared postoperative anterior corneal astigmatism (ACA, in diopters [D]) and root mean square (RMS) values of anterior corneal lower-order (LoA) and higher-order aberrations (HoA) between the groups. Baseline clinical severity grades of pterygium based on the pre-established pterygium body morphology and vascularity, ACA, and AS SS-OCT-guided pterygium morphological profiles (horizontal invasion length [HIL, mm], height [μm], thickness (μm), and residual corneal thickness [RCT]/central corneal thickness [CCT] ratio [RCT/CCT]) were also compared. Postoperative CSI occurred in 26 eyes (28.0%) with a maximum follow-up duration of 22.9±27.4 months. Group 1 exhibited significantly higher postoperative anterior corneal RMS LoA and HoA, as well as the RMS values of the 4th to 6th orders. Although clinical severity grades of pterygium did not differ between groups, baseline ACA was higher in Group 1 (4.56±5.49 D vs. 2.70±3.80 D, P = 0.009). HIL (4.49±0.84 mm vs. 3.77±1.29 mm, P = 0.010) was higher in Group 1, while pterygium height (930.8±84.4 μm vs. 999.3±128.0 μm, P = 0.015) and RCT/CCT ratio (1.07±0.13 vs. 1.14±0.16, P = 0.049) were lower in Group 1. CSI may develop after primary pterygium surgery, particularly in patients with relatively higher preoperative ACA, longer HIL, and shorter height. Given that CSI can significantly increase both lower and higher-order aberrations, it is crucial to anticipate CSI probability and inform patients before surgery.

This study aims to systematically review the reported literature on the use of anterior segment optical coherence tomography (AS-OCT) in ocular surface tumours and simulating lesions. A systematic literature search was done using PubMed, Scopus, and Web of Science databases between January 2002 and December 2021. On AS-OCT, ocular surface squamous neoplasia typically demonstrate epithelial thickening, epithelial hyperreflectivity, and an abrupt transition between normal and abnormal epithelium. Conjunctival nevi usually show mildly hyperreflective epithelium of normal thickness, internal hyperreflectivity, and intralesional cysts which is the hallmark of this tumour. Primary acquired melanosis presents with normal thickness epithelium, basal epithelial hyperreflectivity, and absence of cysts. Conjunctival melanoma demonstrates hyperreflective normal/thickened epithelium, hyperreflective basal epithelium, internal hyperreflectivity, and absence of intralesional cysts. Conjunctival lymphoma shows homogenous, low-medium reflective subepithelial lesions with smooth borders, and dot-like infiltrates. Benign reactive lymphoid hyperplasia findings are similar to lymphoma but the infiltrates are more hyperreflective compared to lymphoma. Pterygium shows thickened conjunctival epithelium, epithelial hyperreflectivity, and subepithelial wedge-shaped hyperreflective tissue separated from the overlying epithelium by a cleavage plane. Pinguecula demonstrates mildly thickened epithelium and similar findings with pterygium but does not extend beyond the corneal limbus. This review shows that AS-OCT, as a noninvasive tool, has potential uses in the differential diagnosis of ocular surface tumours and simulating lesions. Major limitations of AS-OCT include limited visualization of the posterior border of thick, keratinized, and pigmented tumours and lack of assessment of large conjunctival tumours in a single cut.

Background To determine the repeatability of measurements of ocular surface vessel density in normal and diseased eyes using optical coherence tomography angiography (OCTA). Methods Ten normal eyes, 10 pinguecula eyes, and 10 pterygium eyes of 30 volunteers were subjected to OCTA (AngioVue Imaging System, Optovue, Inc.). For scanning, we used the corneal adapter module. Each eye was scanned three times in the nasal and temporal directions, separately. AngioVue software was used to generate the ocular surface vessel density. Ocular surface vessel density was defined as the proportion of vessel area with blood flow to the total measurement area (3 × 3 mm 2 ). Intersession repeatability of the measurement was summarized as the coefficient of variation (CV), and intraclass correlation coefficients (ICC) were calculated by variance component models. Results The CVs were less than 5% in all subjects, and the ICCs exceeded 0.9; thus, all measurements showed good repeatability. The nasal vessels densities differed significantly between healthy eyes and eyes with pterygium ( P  < 0.05); however, there was no significant difference between healthy eyes and eyes with pinguecula ( P  = 0.466). Conclusions These results suggest that measurement of ocular surface vessel density by OCTA in normal eyes and eyes with pterygium and pinguecula is repeatable. This preliminary research describes a quantitative and visual method for assessing vessel density of the ocular surface with a high level of consistency.

PurposeTo introduce a novel practical technique of self-made cryopreservative fibrin glue (SMC) applied in pterygium surgery and to assess its safety and efficacy.MethodsForty-eight eyes of 48 patients with nasal primary pterygium were enrolled. The patients were equally assigned to 6 groups. Self-made fibrin glue was subpackaged and, respectively, cryopreserved for 3, 7, 15 days and 1, 2 and 3 months. At each time point, the asepsis of SMC was confirmed by bacterial culture and colony counting. In each group, corresponding SMC was applied to fix the autograft after the pterygium was removed (e.g., SMC 3d for group 1 and SMC 3m for group 6). All the patients were followed up postoperatively on days 1, 3, 7 and 14 and then at months 1, 3, 6. The main outcome measures included fixation success rate within two tries, postoperative discomfort, recurrence rate and complications.ResultsNo colony growth was observed in all the fibrinogen and thrombin tubes sent. Five patients needed a second try with respective SMC during the autograft fixation, and there were no significant differences in SMC use times among the groups (P = 0.885). There were no significant differences in postoperative discomfort (day 1, 3, 7; P = 0.651, P = 0.269, P = 0.180, respectively) among the groups. By the end of 6-m follow-up, no infections and severe complications were observed in any group. The total recurrence rate was 3/48 (6%), and there were no significant differences in recurrences among the groups (P = 1.000).ConclusionSMC is safe and effective for autograft fixation in pterygium surgery. This new practical technique will benefit the patients and surgeons in developing and underdeveloped country.