PURPOSE: We determined whether elevated serum alkaline phosphatase (ALP) was related to prevalence, location, type, length, and recurrence of pterygium in a population from the Republic of Korea.METHODS: A nationwide cross-sectional dataset, the Korean National Health and Nutrition Examination Survey (2008–2011), was used in this study. All participants were > 30 years of age and underwent the ALP test and ophthalmic evaluation (n = 22,359). One-way analysis of variance, the chi-square test, and Fisher's exact test were used to compare characteristics and outcomes among participants. Multivariable logistic regression was used to examine the possible associations between serum ALP levels and various types of pterygium. Data were adjusted for known risk factors for development of pterygium and ALP elevation (age, sex, residence, sunlight exposure, drinking, smoking, hypertension, diabetes, BMI, AST, ALT, vitamin D, and HDL).RESULTS: The overall prevalence of pterygium was 8.1%, and participants with pterygium had higher levels of serum ALP (p < 0.001). Participants with higher serum ALP had a significantly higher prevalence of all types of pterygium than those in the lower serum ALP quartiles. After adjusting for potential confounding factors, multivariate logistic regression analysis revealed that ALP was associated with the prevalence of pterygium (odds ratio [OR], 1.001; p = 0.038). Trend analysis between the OR and ALP quartiles revealed a linear trend in overall prevalence and in the intermediate type of pterygium. Subgroup analysis revealed a stronger correlation in participants > 50 years of age. One-way analysis of variance revealed an association between the size of pterygium and serum ALP quartile levels. Serum ALP was not associated with recurrence of pterygium.CONCLUSIONS: Increased serum ALP was associated with the prevalence and size of pterygium.
Alkaline Phosphatase ; Cross-Sectional Studies ; Dataset ; Drinking ; Hypertension ; Korea ; Logistic Models ; Nutrition Surveys ; Prevalence ; Pterygium ; Recurrence ; Republic of Korea ; Risk Factors ; Smoke ; Smoking ; Sunlight ; Vitamin D

Objective: This study aims to determine recurrence and complication rates among patients who underwent three current pterygium treatment techniques: preoperative subpterygeal injection of mitomycin C, intraoperative application of mitomycin with pterygium excision and pterygium excision with conjunctival autograft. Methods: This is a randomized controlled clinical trial in a tertiary hospital. We included patients with diagnosed primary pterygium and who underwent either: A = pre-operative injection of 0.02% mitomycin C one month prior to pterygium excision; B = pterygium excision with intraoperative mitomycin C application; or C = pterygium excision with conjunctival autograft. Results: We included 111 patients: a total of 120 eyes randomized to 3 groups (A, B, C) at 40 eyes per group. After 24 months of follow-up, there was no significant difference in the recurrence rates among the groups (6/40 [15%] in groups A and B and 2/40 cases [5%] in group C; P=0.29). No complications were noted in groups B and C, while 1 case of scleral thinning was noted in group A. There was no significant difference in the complication rates among the three procedures (P=1.00). Conclusion There were no significant differences in the recurrence and complication rates among the three techniques. Careful patient selection and follow-up are recommended to prevent complications such as scleral thinning.
Pterygium Of Conjunctiva And Cornea ; Pterygium ; Mitomycin ; Autografts ; Conjunctiva ; Conjunctivitis ; Transplantation, Autologous

OBJECTIVE: To analyze the effects of intradermal needling for pain and tear film stability in patients after pterygium excision. METHODS: A total of 76 patients (98 affected eyes) with primary pterygium were randomly divided into an observation group (38 cases, 53 affected eyes) and a control group (38 cases, 45 affected eyes).In the control group, only pterygium resection was performed, in the observation group, intradermal needling after pterygium resection was applied at Cuanzhu (BL 2), Yuyao (EX-HN 4), Taiyang (EX-HN 5), Sibai (ST 2), Hegu (LI 4), removed after 24 h and changed three times a week. The pain level of 3 days after surgery, dry eye symptoms, the basic tear secretion test (Schirmer-Ⅰ), and the tear-break time (BUT) changes before surgery, 2 weeks after surgery and 4 weeks after surgery were compared between the two groups, and the clinical efficacy was evaluated. RESULTS: The pain level of 3 days after surgery in the observation group was significantly lower than that in the control group (<0.05). The dry eye symptom scores at 2 weeks and 4 weeks after surgery in the two groups were significantly lower than those before surgery (all <0.05), and the dry eye symptom scores in the observation group were significantly lower than those in the control group (both <0.05). The Schirmer-Ⅰ test at 2 weeks and 4 weeks after surgery was significantly prolonged than that before surgery(all <0.05), and the Schirmer-Ⅰ test in the observation group was significantly longer than that in the control group (both <0.05). The BUT at 2 weeks and 4 weeks after surgery in the two groups was significantly longer than that before surgery (all <0.05), and the BUT in the observation group was significantly longer than that in the control group (both <0.05). The total effective rate in the observation group was 89.5% (34/38), which was higher than 71.1% (27/38) in the control group (<0.05). CONCLUSION Intradermal needling can effectively reduce the pain level of patients after pterygium resection, improve dry eye symptoms, promote the secretion of tears and improve the tear film stability.
Acupuncture Points ; Dry Eye Syndromes ; Humans ; Pain ; Pterygium ; Tears

PURPOSE: We introduce a new amniotic membrane (AM) for placement during pterygium surgery. CASE SUMMARY: After excision of the pterygium, we measured the size of the defect with reference to the side opposite the defective area and prepared an AM with margins 1.5–2.0 mm greater than the defect size. The AM was first sutured vertically, with reference to the opposite side of the defect. Then we sutured the upper and lower horizontal axes, and positioned the eye, from the front, slightly away from the direction of the opposite side of the defect. The AM was cut by reference to its boundary at the limbus, and three fixation sutures were placed. CONCLUSIONS: Appropriate AM sizing is important in terms of AM transplantation; the AM is non-elastic and easily torn. Our technique transplants a correctly sized AM and anchors it firmly.
Amnion ; Pterygium ; Sutures

PURPOSE: To investigate risk factors, clinical features, pathogenic organisms, and outcomes in patients with infectious scleritis. METHODS: This study was a retrospective review of 20 patients with infectious scleritis who were admitted from January 2011 to December 2018 in a single tertiary hospital, with at least 3 months of follow-up. We analyzed age, risk factors, clinical manifestations, pathogenic organisms, treatment, and outcomes of infectious scleritis. RESULTS: The mean patient age was 69.2 ± 8.4 years and the mean duration of hospitalization was 11.3 ± 5.8 days. Furthermore, the mean duration of symptoms before presentation was 16.8 ± 13.9 days; patients were followed for a mean duration of 23.3 ± 25.4 months. All patients had prior pterygium surgery. Eighteen patients (90%) were culture-positive and Pseudomonas aeruginosa (P. aeruginosa) was identified in 12 eyes. In the acute stages, adjuvant surgical intervention was performed for 18 patients (90%) for these patients, the mean duration of hospitalization before surgery was 4.1 ± 4.4 days. CONCLUSIONS: The most common risk factor and pathogenic organism for infectious scleritis were prior pterygium surgery and P. aeruginosa, respectively. Identification of specific causative organisms and corresponding antibiotic treatment with adjuvant surgical intervention may improve visual prognosis in patients with infectious scleritis.
Eye Infections ; Follow-Up Studies ; Hospitalization ; Humans ; Prognosis ; Pseudomonas aeruginosa ; Pterygium ; Retrospective Studies ; Risk Factors ; Scleritis ; Tertiary Care Centers

We investigated relationships between outdoor air pollution and pterygium in Korean adults. This study includes 23,276 adults in population-based cross-sectional data using the Korea National Health and Nutrition Examination Survey 2008–2011. Pterygium was assessed using slit lamp biomicroscopy. Air pollution data (humidity, particulate matter with aerodynamic diameter less than 10 μm [PM₁₀], ozone [O₃], nitrogen dioxide [NO₂], and sulfur dioxide levels [SO₂]) for 2 years preceding the ocular examinations were acquired. Associations of multiple air pollutants with pterygium or pterygium recurrence after surgery were examined using multivariate logistic models, after adjusting for several covariates. Distributed lag models were additionally used for estimating cumulative effects of air pollution on pterygium. None of air pollution factors was significantly associated with pterygium or pterygium recurrence (each P > 0.05). Distributed lag models also showed that air pollution factors were not associated with pterygium or pterygium recurrence in 0-to-2 year lags (each P > 0.05). However, primary pterygium showed a weak association with PM₁₀ after adjusting for covariates (odds ratio [OR] 1.23; [per 5 μg/m³ PM₁₀ increase]; P = 0.023). Aging, male sex, and greater sun exposure were associated with pterygium, while higher education level and myopia were negatively associated with pterygium (each P ≤ 0.001). Male sex and myopia were negatively associated with pterygium recurrence (each P < 0.05). In conclusion, exposure to higher PM10 levels was associated with primary pterygium, although this study observed no significant association between air pollution and overall pterygium or pterygium recurrence in Korean adults.
Adult ; Aging ; Air Pollutants ; Air Pollution* ; Education ; Humans ; Korea* ; Logistic Models ; Male ; Myopia ; Nitrogen Dioxide ; Nutrition Surveys ; Ozone ; Particulate Matter ; Pterygium* ; Recurrence ; Slit Lamp ; Solar System ; Sulfur Dioxide

PURPOSE: We report a case of spontaneous corneal perforation combined with primary pterygium. CASE SUMMARY: A 66-year-old male presented with a foreign body sensation in his right eye. He had no systemic or ocular inflammatory diseases. He had undergone penetrating keratoplasty following amniotic membrane transplantation for corneal perforation at 1 day after pterygium excision in his left eye. The uncorrected visual acuity (UCVA) and intraocular pressure (IOP) in his right eye were 0.8 and 2 mmHg, respectively. Active leakage of an aqueous humor on the head of the pterygium was found on slit lamp examination. With the impression of spontaneous corneal perforation combined with primary pterygium, emergent amniotic membrane transplantation was performed. Diffuse corneal thinning around the 2 mm-sized perforation site was found 3mm away from the limbus in the 5 o'clock after removing the pterygium. The perforation site was covered with amniotic membrane after applying fibrin glue. UCVA and IOP in his right eye were 1.0 and 9 mmHg, respectively, at postoperative 6 months. No definite recurrence of pterygium or additional corneal perforation was found. CONCLUSIONS: Spontaneous corneal perforation may be related to primary pterygium.
Aged ; Amnion ; Aqueous Humor ; Corneal Perforation* ; Fibrin Tissue Adhesive ; Foreign Bodies ; Head ; Humans ; Intraocular Pressure ; Keratoplasty, Penetrating ; Male ; Pterygium* ; Recurrence ; Sensation ; Slit Lamp ; Visual Acuity

PURPOSE: To evaluate the efficacy and safety of pterygium excision using a large conjunctival autograft for the treatment of recurrent pterygium. METHODS: The medical records of 120 patients (126 eyes) with recurrent pterygium were reviewed. For each affected eye, pterygium excision with a large conjunctival autograft was performed. The graft was harvested from the superior bulbar area and measured more than 8 × 10 mm in size. Only patients who completed at least six months of follow-up were included. Postoperative clinical outcomes, recurrence rate, and complications were analyzed. Patients with any evidence of recurrence after surgery received a subconjunctival bevacizumab injection. RESULTS: The average patient age was 56.5 ± 10.2 years, and 45 out of 120 patients were male. The mean study follow-up period was 17.7 ± 17.6 months. Most patients were satisfied with the cosmetic outcome. Postoperative visual acuity improved from 0.69 to 0.75 (p < 0.05). Postoperative refractive astigmatism and corneal astigmatism decreased by 0.55 and 2.73 diopters, respectively (p < 0.05). The postoperative recurrence rate was 4.0%, and the average recurrence period was 7.4 ± 0.6 weeks. A subconjunctival injection of 5 mg bevacizumab was performed in cases of recurrence; no progression of the pterygium was observed following the injection. Postoperative complications included 2 cases of conjunctival graft edema in 2 eyes, 5 donor site scars in 5 eyes, 13 pyogenic granulomas in 13 eyes, and a conjunctival epithelial inclusion cyst in 7 eyes. CONCLUSIONS: Pterygium excision with a large conjunctival autograft for the treatment of recurrent pterygium produced an excellent cosmetic outcome, a low recurrence rate, and minimal complications. A subconjunctival bevacizumab injection given in cases of recurrence following surgery might be effective in preventing progression of the pterygium.
Astigmatism ; Autografts* ; Bevacizumab ; Cicatrix ; Edema ; Follow-Up Studies ; Granuloma, Pyogenic ; Humans ; Male ; Medical Records ; Postoperative Complications ; Pterygium* ; Recurrence ; Tissue Donors ; Transplants ; Visual Acuity

PURPOSE: To analyze the long-term clinical outcomes after use of fibrin glue using a modified mini-flap technique for pterygium surgery. METHODS: This study is a retrospective, clinical outcome study of 148 subjects that underwent the modified mini-flap technique with fibrin glue from January 2014 to August 2015. We analyzed the recurrence rate and surgical time of modified mini-flap surgery with fibrin glue. We also analyzed associating factors between the recurrence group and non-recurrence group who underwent the same surgery technique. RESULTS: Mean age was 60.2 ± 1.1 (ranging from 29 to 86) years, and mean surgical time was 11.8 ± 5.8 (ranging from 5 to 36) minutes. The recurrence rate of pterygium patients who underwent the fibrin glue using a modified mini-flap technique was 4.0% (6/148), and the re-operation rate was 0.6% (1/148). From the comparison of associating factors between recurred and non-recurred groups, the recurred group was younger, had more severe disease, and had a higher rate of bilaterality than the non-recurred group (p < 0.05). CONCLUSIONS: The new approach using fibrin glue with a modified mini-flap technique shows a low recurrence rate compared to the other type of pterygium surgery. The use of fibrin glue shortened operation time and decreased patient discomfort due to fewer remnant sutures. Fibrin glue use in a modified mini-flap technique can be considered as a feasible surgical option for pterygium patients.
Fibrin Tissue Adhesive* ; Fibrin* ; Humans ; Operative Time ; Outcome Assessment (Health Care) ; Pterygium* ; Recurrence ; Retrospective Studies ; Sutures

PURPOSE: To investigate the types of corneal higher-order aberration (HOA) induced by pterygium, residual corneal HOA after pterygium surgery, and correlations between corneal HOA and the length of the pterygium. METHODS: Fifty-three patients who underwent pterygium excision with conjunctival autograft were enrolled. Corneal HOA was measured by Pentacam® (Oculus Inc., Wetzlar, Germany) preoperatively and 3 months postoperatively in the 6-mm optical zone. Preoperative and postoperative HOAs of eyes with pterygium were compared with HOAs of the fellow eye to evaluate HOAs induced by pterygium and residual HOAs after pterygium surgery. Partial correlation analysis was performed to investigate the relationship between HOAs and the length of pterygium. A postoperative HOA less than 0.35 µm in size was defined as a favorable surgical outcome and the surgical indications were estimated using receiver operator characteristic (ROC) curve. RESULTS: Horizontal coma, root mean square (RMS) of coma, oblique trefoil, horizontal trefoil, RMS of trefoil, and total HOA were significantly greater in the eye with preoperative pterygium. Three months after pterygium excision, only RMS of coma and total HOA remained significantly greater in eyes with pterygium. Vertical coma, horizontal coma, RMS of coma, and oblique tetrafoil were correlated with pterygium length. Pterygium excision when pterygium length was less than 1.6 mm led to favorable surgical outcomes. CONCLUSION: Pterygium induced greater than third-order corneal HOAs and these HOAs were corrected via pterygium surgery. Longer pterygium length was associated with larger RMS of coma and larger coma RMS persisted after pterygium surgery. A pterygium length of 1.6 mm should be considered the cutoff for pterygium excision for reducing postoperative corneal HOA.
Autografts ; Coma ; Humans ; Lotus ; Pterygium*