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      Pterygium: Nonsurgical Treatment Using Topical Dipyridamole - A Case Report

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          Abstract

          Purpose: We report a case of a symptomatic, inflamed pterygium treated nonsurgically with topical dipyridamole and followed for 12 months. Case Report: A 35-year-old woman presented with a stage II to III, V3, C3, K2, P1 (using Johnston, Williams & Sheppard's classification) pterygium in her right eye. She complained of a foreign body sensation, dryness, burning, and persistent uncontrolled blinking. A raised lesion was observed on the nasal conjunctiva that was 1.5 mm in size. It extended slightly onto the nasal cornea. There was moderate vascularity of the lesion that obscured the underlying scleral vessels. Moderate conjunctival hyperemia was detected at and medial to the pterygium. The cornea, anterior chamber, and external anatomy were otherwise unremarkable. The eye was initially treated twice daily with a topical application of dipyridamole in a normal saline solution, which was later reduced to once daily. Results: There was a marked improvement in both the pterygium and the patient's symptoms. The tissue regressed from the limbal region of the cornea, had decreased in length from 1.5 to 1.0 mm, and decreased in height from approximately 1.0 to approximately 0.3 mm. Conjunctival hyperemia and vascularization resolved completely, and the underlying scleral vessels could once again be visualized. At 12 months, the pterygium was graded as stage 0 to I, V0, C2, K0, P0. Conclusions: To our knowledge, this is the first case of successful management of a pterygium and associated symptoms using topical dipyridamole. Further investigation is required to clarify the potential role of dipyridamole in the treatment of pterygia and pingueculae.

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          Most cited references20

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          Ophthalmic pterygium: a stem cell disorder with premalignant features.

          Pterygia are common ocular surface lesions thought to originate from limbal stem cells altered by chronic UV exposure. Traditionally regarded as a degenerative condition, pterygia also display tumor-like features, such as a propensity to invade normal tissue and high recurrence rates following resection, and may coexist with secondary premalignant lesions. This study was initiated to determine the rate of concurrent ocular surface diseases in patients with pterygia recruited from the practice of a single surgeon operating in a Sydney metropolitan hospital. One hundred pterygium specimens were histopathologically reviewed and selected cases were immunohistochemically assessed to confirm diagnosis. Along with previously documented typical features including epithelial proliferation, goblet cell hyperplasia, angiogenesis, inflammation, elastosis, stromal plaques, and Bowman's membrane dissolution, we identified five cases of ocular surface squamous neoplasia, six cases of primary acquired melanosis, two compound nevi (one suspect invasive melanoma), and one dermoid-like lesion. In 18 specimens, clusters of basal epithelial cells that coexpressed cytokeratin-15/-19 and p63-α were identified at the head of the pterygium, coinciding with clinical observation of Fuchs' flecks. Our data show that significant preneoplastic lesions may be associated with pterygium and that all excised pterygia should undergo histological examination. The presence of p63-α-positive epithelial cell clusters supports the hypothesis that pterygia develop from limbal epithelial progenitors. Copyright © 2011 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.
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            The pathogenesis of pterygia.

            Pterygium is an active, invasive, inflammatory process, a key feature of which is focal limbal failure. In a two-stage process, "conjunctivalization" of the cornea occurs with tissue characterized by extensive chronic-inflammation, cellular proliferation, connective tissue remodeling, and angiogenesis. An understanding of this process has resulted in efforts aimed at limbal reconstruction, which is considered the gold standard for surgical care. Although good results have been obtained with other treatment methods, a long-term approach to follow-up with at least 5-year survival figures is desirable. Sophisticated analyses of the tear film and surface epithelium in patients with pterygium may help explain symptoms. The efficacy, at least in the short term, of nonsteroidal anti-inflammatory drugs in the treatment of inflamed pterygia has been confirmed. Corneal topographic analysis has shown that surgery reduces induced astigmatism and also causes subtle changes that may explain postsurgical improvements in vision.
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              Current concepts and techniques in pterygium treatment.

              Pterygium is a common ocular disorder in many parts of the world. At present, there is a wide variety of surgical methods but very few clinical guidelines on the optimal treatment of primary or recurrent pterygium. The purpose of this review is to summarize the more recent and relevant studies on pterygium treatment. The primary aim is to excise the pterygium and prevent its recurrence. As bare sclera excision is associated with a high recurrence rate, pterygium excision is often combined with conjunctival autograft, mitomycin C, beta-irradiation or other adjunctive therapies to reduce recurrence rates. There is currently, however, no consensus regarding the ideal treatment for the disease. Comparability between studies is also hampered by the various definitions of pterygium recurrence. This article reviews the current concepts and techniques used for the treatment of pterygium. Conjunctival autografting and mitomycin C application are the most commonly used methods for preventing recurrences. The use of mitomycin C and beta-irradiation should be used judiciously because of the potential long-term risk of sight-threatening complications. Additional clinical trials should be performed to evaluate the relative efficacies and long-term safety of the various treatment modalities.
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                Author and article information

                Journal
                COP
                COP
                10.1159/issn.1663-2699
                Case Reports in Ophthalmology
                S. Karger AG
                1663-2699
                2014
                January – April 2014
                25 March 2014
                : 5
                : 1
                : 98-103
                Affiliations
                aVisionWorks, Lancaster, Pa., USA; bMedInsight Research Institute, Telz Stone, Israel
                Author notes
                *Moshe Rogosnitzky, MedInsight Research Institute, Yitzchak 37, Telz Stone 9083800 (Israel), E-Mail moshe@medinsight.org
                Article
                362113 PMC3995373 Case Rep Ophthalmol 2014;5:98-103
                10.1159/000362113
                PMC3995373
                24761148
                43da40ce-dd78-4673-a1b7-4ea19ad821c2
                © 2014 S. Karger AG, Basel

                Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) ( http://www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Figures: 3, Pages: 6
                Categories
                Published: March 2014

                Vision sciences,Ophthalmology & Optometry,Pathology
                Pterygium,Dipyridamole,Surfer’s eye,Pterygia
                Vision sciences, Ophthalmology & Optometry, Pathology
                Pterygium, Dipyridamole, Surfer’s eye, Pterygia

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