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翼状胬肉的发病机制及临床治疗进展
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Abstract:
翼状胬肉是一种球结膜下纤维血管生长,穿过角膜缘并延伸到外周角膜,在某些情况下会导致严重的视觉并发症。据报道,该疾病在世界不同地区的患病率为1.2%至约40%。虽然翼状胬肉有各种危险因素,包括紫外线(UV)辐射、病毒感染、遗传因素、免疫因素、无菌性炎症和环境刺激,但翼状胬肉的发病机制主要与暴露于紫外线有关。手术是翼状胬肉的主要治疗方法,各种技术如裸巩膜、旋转结膜瓣、自体角膜缘结膜移植、羊膜移植和自体游离结膜移植用于翼状胬肉的切除。新的治疗方法似乎也大大减少了令人担忧的复发问题。
Pterygium is a bulbar conjunctival fibrovascular growth that crosses the corneal limbus and ex-tends into the peripheral cornea, leading to serious visual complications in some cases. The preva-lence of the disease has been reported to range from 1.2% to approximately 40% in different parts of the world. Although there are various risk factors for pterygium, including ultraviolet (UV) radia-tion, viral infections, genetic factors, immunologic factors, aseptic inflammation, and environmental stimuli, the pathogenesis of pterygium is primarily related to exposure to UV light. Surgery is the mainstay of treatment for pterygium and various techniques such as bare sclera, rotational con-junctival flaps, autologous corneal limbal conjunctival grafts, amniotic membrane grafts and autol-ogous free conjunctival grafts are used for pterygium excision. Newer treatments also seem to have greatly reduced the worrisome problem of recurrence.
[1] | Zaidi, S.B.H. and Ali Khan, W. (2021) Is Pterygium Morphology Related to Loss of Corneal Endothelial Cells? A Cross-Sectional Study. Clinical Ophthalmology, 15, 1259-1266. https://doi.org/10.2147/OPTH.S296531 |
[2] | Zhao, D., Zhao, H., He, Y., et al. (2021) The Inhibitive Effects of Proteasome Inhibitor MG-132 on Pterygium Fibroblasts in vitro and the Potential Key Regulators Involved. Life Sciences, 270, Article ID: 119088.
https://doi.org/10.1016/j.lfs.2021.119088 |
[3] | Zhou, W.P., Zhu, Y.F., Zhang, B., et al. (2016) The Role of Ultravi-olet Radiation in the Pathogenesis of Pterygia (Review). Molecular Medicine Reports, 14, 3-15. https://doi.org/10.3892/mmr.2016.5223 |
[4] | Shahraki, T., Arabi, A. and Feizi, S. (2021) Pterygium: An Update on Pathophysiology, Clinical Features, and Management. Therapeutic Advances in Ophthalmology, Vol. 13. https://doi.org/10.1177/25158414211020152 |
[5] | Wanzeler, A.C.V., Duarte, B., de Andrade, V.D.M., et al. (2018) Impact of Conjunctival Autograft on Pterygium Treatment: Evaluation of Related Symptoms and Patients’ Satisfaction after Surgery. Clinical Ophthalmology, 12, 833-837. https://doi.org/10.2147/OPTH.S155631 |
[6] | Baheran, S.S., Alany, R.G., Schwikkard, S., et al. (2023) Pharmacological Treatment Strategies of Pterygium: Drugs, Biologics, and Novel Natural Products. Drug Discovery Today, 28, Article ID: 103416.
https://doi.org/10.1016/j.drudis.2022.103416 |
[7] | Martín-López, J., Pérez-Rico, C., Benito-Martínez, S., et al. (2021) The Role of the Stromal Extracellular Matrix in the Development of Pterygium Pathology: An Update. Journal of Clinical Medicine, 10, Article 5930.
https://doi.org/10.3390/jcm10245930 |
[8] | Elgouhary, S.M., Elmazar, H.F., Naguib, M.I., et al. (2020) Role of Oxidative Stress and Vascular Endothelial Growth Factor Expression in Pterygium Pathogenesis and Prevention of Pter-ygium Recurrence after Surgical Excision. International Ophthalmology, 40, 2593-2606. https://doi.org/10.1007/s10792-020-01440-2 |
[9] | Zavala, J., Hernandez-Camarena, J.C., Salvador-Gálvez, B., et al. (2018) Extracellular Matrix and Fibroblast Injection Produces Pterygium-Like Lesion in Rabbits. Biological Research, 51, Article No. 15.
https://doi.org/10.1186/s40659-018-0165-8 |
[10] | Tan, J., Vollmer-Conna, U., Tat, L., et al. (2019) Dry-Eye Disease in Recurrent Pterygium. Ophthalmic Research, 61, 199-203. https://doi.org/10.1159/000493544 |
[11] | He, S. and Wu, Z. (2022) Biomarkers in the Occurrence and Development of Pterygium. Ophthalmic Research, 65, 481-492. https://doi.org/10.1159/000523878 |
[12] | Watanabe, M., Tsugeno, Y., Sato, T., et al. (2023) TGF-β Isoforms Affect the Planar and Subepithelial Fibrogenesis of Human Conjunctival Fibroblasts in Different Manners. Biomedicines, 11, Article 2005.
https://doi.org/10.3390/biomedicines11072005 |
[13] | Casciano, F., Zauli, E., Busin, M., et al. (2023) State of the Art of Pharmacological Activators of p53 in Ocular Malignancies. Cancers, 15, Article 3593. https://doi.org/10.3390/cancers15143593 |
[14] | Yazar, S., Cuellar-Partida, G., Mcknight, C.M., et al. (2015) Genetic and Environmental Factors in Conjunctival UV Autofluorescence. JAMA Ophthalmology, 133, 406-412. https://doi.org/10.1001/jamaophthalmol.2014.5627 |
[15] | Anguria, P., Carmichael, T., Ntuli, S., et al. (2013) Chronic Inflammatory Cells and Damaged Limbal Cells in Pterygium. African Health Sciences, 13, 725-730. https://doi.org/10.4314/ahs.v13i3.29 |
[16] | Romano, V., Steger, B., Kovacova, A., et al. (2016) Further Evidence for Heredity of Pterygium. Ophthalmic Genetics, 37, 434-436. https://doi.org/10.3109/13816810.2015.1111911 |
[17] | Sámano-Hernández, L., Garfias, Y., González-Márquez, H., et al. (2023) Human Papilloma Virus Presence and Its Physical Status in Primary Pterygium. Heliyon, 9, e16189. https://doi.org/10.1016/j.heliyon.2023.e16189 |
[18] | Fernandes, M., Sangwan, V.S., Bansal, A.K., et al. (2005) Outcome of Pterygium Surgery: Analysis over 14 years. Eye, 19, 1182-1190. https://doi.org/10.1038/sj.eye.6701728 |
[19] | Jee, D., Park, M., Lee, H.J., et al. (2015) Comparison of Treatment with Preservative-Free Versus Preserved Sodium Hyaluronate 0.1% and Fluorometholone 0.1% Eyedrops after Cataract Surgery in Patients with Preexisting Dry-Eye Syndrome. Journal of Cataract and Refractive Surgery, 41, 756-763. https://doi.org/10.1016/j.jcrs.2014.11.034 |
[20] | Hwang, H.S., Cho, K.J., Rand, G., et al. (2018) Optimal Size of Pterygium Excision for Limbal Conjunctival Autograft Using Fibrin Glue in Primary Pterygia. BMC Ophthalmology, 18, Article No. 135.
https://doi.org/10.1186/s12886-018-0790-6 |
[21] | Bilge, A.D. (2018) Comparison of Conjunctival Autograft and Conjunctival Transposition Flap Techniques in Primary Pterygium Surgery. Saudi Journal of Ophthalmology: Official Journal of the Saudi Ophthalmological Society, 32, 110-113. https://doi.org/10.1016/j.sjopt.2017.11.002 |
[22] | Akbari, M. (2022) Update on Overview of Pterygium and Its Sur-gical Management. Journal of Population Therapeutics and Clinical Pharmacology, 29, e30-e45. https://doi.org/10.47750/jptcp.2022.968 |
[23] | Sabater-Cruz, N., Dotti-Boada, M., Rios, J., et al. (2021) Postopera-tive Treatment Compliance Rate and Complications with Two Different Protocols after Pterygium Excision and Conjunc-tival Autografting. European Journal of Ophthalmology, 31, 932-937. https://doi.org/10.1177/1120672120917335 |
[24] | Paganelli, B., Sahyoun, M. and Gabison, E. (2023) Conjunctival and Limbal Conjunctival Autograft vs. Amniotic Membrane Graft in Primary Pterygium Surgery: A 30-Year Compre-hensive Review. Ophthalmology and Therapy, 12, 1501-1517. https://doi.org/10.1007/s40123-023-00689-x |
[25] | ?zdemi,r M. (2008) Conjunctival Z-Plasty for Pterygium: Com-parison with Conjunctival Autografting. Electronic Journal of General Medicine, 5, 84-89. https://doi.org/10.29333/ejgm/82583 |
[26] | Young, A.L. and Kam, K.W. (2019) Pterygium: Surgical Techniques and Choices. Asia-Pacific Journal of Ophthalmology, 8, 422-423. https://doi.org/10.1097/APO.0000000000000269 |
[27] | Kaufman, S.C., Jacobs, D.S., Lee, W.B., et al. (2013) Op-tions and Adjuvants in Surgery for Pterygium: A Report by the American Academy of Ophthalmology. Ophthalmology, 120, 201-208.
https://doi.org/10.1016/j.ophtha.2012.06.066 |
[28] | Luanratanakorn, P., Ratanapakorn, T., Suwan-Apichon, O., et al. (2006) Randomised Controlled Study of Conjunctival Autograft versus Amniotic Membrane Graft in Pterygium Excision. The British Journal of Ophthalmology, 90, 1476-1480. https://doi.org/10.1136/bjo.2006.095018 |
[29] | Fakhry, M.A. (2011) The Use of Mitomycin C with Autologous Limbal-Conjunctival Autograft Transplantation for Management of Recurrent Pterygium. Clinical Ophthalmology, 5, 123-127.
https://doi.org/10.2147/OPTH.S16474 |
[30] | Mutlu, F.M., Sobaci, G., Tatar, T., et al. (1999) A Comparative Study of Recurrent Pterygium Surgery: Limbal Conjunctival Autograft Transplantation versus Mitomycin C with Conjunctival Flap. Ophthalmology, 106, 817-821.
https://doi.org/10.1016/S0161-6420(99)90172-0 |
[31] | Zhang, Q., Bao, N., Liang, K., et al. (2018) Adjuvant Use of Cyclosporine A in the Treatment of Primary Pterygium: A Systematic Review and Meta-Analysis. Cornea, 37, 1000-1007. https://doi.org/10.1097/ICO.0000000000001542 |
[32] | Mandal, A., Gote, V., Pal, D., et al. (2019) Oc-ular Pharmacokinetics of a Topical Ophthalmic Nanomicellar Solution of Cyclosporine (Cequa?) for Dry Eye Disease. Pharmaceutical Research, 36, Article No. 36.
https://doi.org/10.1007/s11095-018-2556-5 |
[33] | Zhai, L.Y., Zhang, X.R., Liu, H., et al. (2020) Observation of Topical Tacrolimus on High-Risk Penetrating Keratoplasty Patients: A Randomized Clinical Trial Study. Eye, 34, 1600-1607.
https://doi.org/10.1038/s41433-019-0717-3 |
[34] | Hacio?lu, D. and Erd?l, H. (2017) Developments and Current Approaches in the Treatment of Pterygium. International Ophthalmology, 37, 1073-1081. https://doi.org/10.1007/s10792-016-0358-5 |
[35] | Wu, H. and Chen, G. (1999) Cyclosporine A and Thiotepa in Prevention of Postoperative Recurrence of Pterygium. Yan Ke Xue Bao, 15, 91-92. (In Chinese) |
[36] | Yu, J., Feng, J., Jin, T., et al. (2021) The Effect of a Novel Strategy in Treating Primary Pterygium: A Prospective Randomized Clinical Study. American Journal of Ophthalmology, 225, 108-116.
https://doi.org/10.1016/j.ajo.2021.01.001 |
[37] | Yin, M., Li, H., Zhang, Y., et al. (2019) Interferon Alpha-2b Eye Drops Prevent Recurrence of Pterygium after the Bare Sclera Technique: A Single-Center, Sequential, and Controlled Study. Cornea, 38, 1239-1244.
https://doi.org/10.1097/ICO.0000000000001995 |
[38] | Razeghinejad, M.R. and Banifatemi, M. (2014) Subconjunc-tival Bevacizumab for Primary Pterygium Excision; A Randomized Clinical Trial. Journal of Ophthalmic & Vision Re-search, 9, 22-30. |
[39] | Fallah, M.R., Khosravi, K., Hashemian, M.N., et al. (2010) Efficacy of Topical Bevacizumab for Inhibiting Growth of Impending Recurrent Pterygium. Current Eye Research, 35, 17-22. https://doi.org/10.3109/02713680903395273 |
[40] | Papathanassiou, M., Theodossiadis, P.G., Liarakos, V.S., et al. (2008) Inhibition of Corneal Neovascularization by Subconjunctival Bevacizumab in an Animal Model. American Jour-nal of Ophthalmology, 145, 424-431.
https://doi.org/10.1016/j.ajo.2007.11.003 |
[41] | Mansour, A.M. (2009) Treatment of Inflamed Pterygia or Residual Pterygial Bed. The British Journal of Ophthalmology, 93, 864-865. https://doi.org/10.1136/bjo.2008.155291 |
[42] | Kim, H.K., Choi, J.Y., Park, S.M., et al. (2017) Tyrosine Kinase In-hibitor, Vatalanib, Inhibits Proliferation and Migration of Human Pterygial Fibroblasts. Cornea, 36, 1116-1123. https://doi.org/10.1097/ICO.0000000000001268 |