Diapositiva 1

1
Department of Ophthalmology University of Siena,
Italy
PTERYGIUM PROGRESSION DETECTED BY IN VIVO
CONFOCAL MICROSCOPY
Martone Gianluca, Malandrini Alex, Balestrazzi
Angelo, Tosi Gian Marco, Pichierri Patrizia ,
Caporossi Aldo
2
No author has a financial or proprietary interest
in any material or method mentioned
3
Introduction
Pterygium is a benign growth of the conjunctiva
from the nasal side of the sclera towards the
centre of the cornea. It is associated with, and
thought to be caused by ultraviolet-light
exposure. The pathogenesis is still debated (1).
The histopathology is characterized by basophilic
degenerative fibrovascular tissue invading the
superficial cornea with destruction of the
underlying Bowmans membrane. IVCM is becoming a
useful diagnostic tool for ocular surface imaging
to describe limbus and corneal diseases (2). It
can provide details of ocular structures at the
cellular level . In some studies, IVCM was used
to examine the typical structure of pterygium
(3-4).
4
To perform a qualitative assessment of anatomical
and pathological changes in the cornea and
conjunctiva of patients affected by pterygium and
to describe the typical components of progressive
and not-progressive pterygium by IVCM.
Purpose
5
40 eyes of 32 patients with primary pterygium was
examined by slit lamp examination and IVCM in a
prospective randomized double blind study. IVCM
(Heidelberg Retina Tomograph II with the Rostock
Cornea Module) analysis was performed in two
different corneal areas, in the central and
peripheral pterygium zone. The IVCM images (400
µm x 400 µm) were acquired from the periphery to
central pterygium areas. During the examination,
all subjects were asked to fixate external light
target in order to good visualization of the
pterygium. All eyes were evaluated at baseline,
after 6 and 12 months. After 12 months they were
classified in two groups progressive and
non-progressive group.
Methods
6
Results Progressive group
Irregular corneal epithelium adjacent to the
pterygium head and not well defined transfer zone
Actvated keratocytes and stromal edema at body of
pterygium
Many capillaries and an important infiltration of
dendritic cells in pterygium head
Cloudy and hyperreflective margin of the apex head
Hyperreflective formations as scars that could be
Bowmans membrane breaks
7
Results Not progressive group
Irregular epithelium morphology adjacent to the
head of the pterygium but the margins are well
defined
Reduction of stromal edema with low activated
keratocytes and low inflammatory cells and vessels
Bright intracellular inclusions in the basal
epithelial cell layer (Stoker s line) and the
surrounding epithelium appears absolutely normal
Many irregular hypereflective areas were also
present between the head of pterygium and
adjacent cornea (Fuchs' dots)
8
Discussion
In this study, IVCM was used to examine the
typical structure of primary pterygium. The body
and the head of the pterygium and the corneal
epithelium and stroma adjacent to the pterygium
head were characterized by the presence of
different findings between the progressive and
not-progressive groups. Significant correlations
were found between clinical progression of the
pterygium and IVCM parameters. Furthermore, the
findings obtained by IVCM suggest that it may be
helpful as a non-invasive and uncomplicated
method to study the anatomical structural corneal
and conjunctival changes in patients with
pterygium and understanding its condition of
progression. Larger studies should be carried out
to understand further the changes at the level of
the cornea induced by the pterygium and correlate
them with signs of clinical progression to plan
the surgery.
9
References

1. Hill JC Maske R. Pathogenesis of pterygium. Eye
   19893218226.
2. Cavanagh HD, Petroll WM, Alizadeh H et al.
   Clinical and diagnostic use of in vivo confocal
   microscopy in patients with corneal disease.
   Ophthalmology 19931001444-54
3. Papadia M, Barabino S, Valente C, Rolando M.
   Anatomical and immunological changes of the
   cornea in patients with pterygium. Curr Eye Res
   200833429-34.
4. Gheck L, Dupas B, Denion E, Amar N, Baudouin C.
   Advantages of in vivo confocal microscopy for
   investigation of the pterygium. J Fr Ophtalmol
   200730703-10.