PERTUMBUHAN JARINGAN FIBROVASKULER BERBENTUK SEGITIGA DENGAN APEKS SELALU DI KORNEABERSIFAT DEGENERATIF DAN INVASIF

MUTASI GEN P53 MENURUNKAN APOPTOSISMENINGKATKAN TGF-bLIMBAL STEM CELL DEFFICIENCY

PAPARAN UVPAPARAN ANGINPAPARAN DEBUKELEMBABAN UDARA YG KURANGDRY EYE SYNDROME

PTERYGIUM

Elastotic degeneration fragmentation and breakdown of stromal collagen

Destruction of Bowmans layer by advancing fibrovascular tissue resulting in corneal scarring

in the advancing head of a pterygium, conjunctival-like epithelium (Conj) merges abruptly into corneal epithelium (Corn). The underlying Bowman's layer (arrows) is fragmented and precedes a fibrovascular stroma (asterisk).

Goblet cell hyperplasia is apparent in pterygium (B), compared with donor-matched conjunctiva (C).

Prominent central feeder vessel; inset shows dilated subepithelial vessels

E: Elastotic changes (double asterisk) in pterygium stroma. F: Inflammatory infiltrates in the epithelium. G: Stromal vessels loaded with polymorphonuclear leukocytes.

Note the severe solar elastosis beneath the epithelium on the right-half of this photomicrograph. The dilated vessels beneath the epithelium to the left correspond to the "injection" seen clinically

Grading of pterygium helps for managementDepending on Size- Grade 1 Grade 2 Grade 3

VariantsCystic degeneration

Bidirectional

Pseudo pterygium present anywhere, neck bridges limbus

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ObservationAsymptomatic , grade 1 pterygium

Medical ManagementSymptomatic Grade 1 and 2 pterygiumEye drops Tear substitutes, DecongestantsLocal injections anti VEGFs, Steroid

Surgical Management**

No sutures or fine, absorbable sutures used to appose conjunctiva to superficial sclera in front of rectus tendon insertionLeaves area of bare scleraRelatively high recurrence rate with variable techniques of 5 68 % with primary / 35 82 % with recurrent)

Indications-Symptomatic patients recurrent irritation, redness and watering Visual needcovering visual axis or threatening visual axiscausing irregular astigmatism Grade 2 and 3 PterygiumCosmeticTherapeutic suspected associated neoplastic degenerationmotility restriction**

Reported recurrence rates are variable (between 0 40 %) Few complicationsFurther prospective studies in primary and recurrent pterygia are needed