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      Association between pterygium, sun exposure, and serum 25-hydroxyvitamin in a nationally representative sample of Korean adults

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          Abstract

          Purpose

          Ultraviolet-B (UVB) light exposure is the major risk factor for developing a pterygium, and serum 25-hydroxyvitamin D (25(OH)D) level is an objective measure of UVB light exposure. In this study, we investigated the association between pterygium, sun exposure, and serum 25(OH)D.

          Methods

          This population-based, cross-sectional study comprised 12,258 adults (aged ≥19 years) participating in the fifth annual Korea National Health and Nutrition Examination Survey from 2010 to 2012. The enrolled subjects underwent interviews, clinical examinations, and laboratory investigations. The serum 25(OH)D levels were measured, and pterygium was examined by using a slit lamp. We used three adjusted logistic regression models and selected covariates as potential confounders.

          Results

          The overall prevalence of pterygium was 7.09, and 53.1% of these subjects were women. The prevalence of pterygium was higher in elderly subjects and those who lived at low latitudes. In multivariate analysis with adjustment for confounding factors, subjects with a serum 25(OH)D level > 30 ng/mL, 25–30 ng/mL, and 15–20 ng/mL had an odds ratio (OR) (95% confidence interval [CI]) of 1.565 (1.035–2.366), 1.545 (1.086–2.198), 1.8 (1.358–2.386), and 1.535 (1.216–1.938), respectively, compared to those with a serum 25(OH)D level < 15 ng/mL. Subjects with a daily sun exposure > 5 h had an OR (95% CI) of 1.761 (1.395–2.223) compared to subjects with a daily sun exposure < 2 h.

          Conclusion

          The present study provides epidemiological evidence of an association of daily sun exposure and serum 25(OH)D levels with pterygium in a representative Korean population.

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          Most cited references33

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          Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision.

          To compare success rates of conjunctival autografting and bare sclera excision for primary and recurrent pterygium in the tropics and to evaluate risk factors for pterygium recurrence. A prospective, controlled clinical trial was performed in which 123 primary and 34 recurrent pterygia, matched for age and pterygium morphology, were randomized in 2 separate studies to receive either bare sclera excision or conjunctival autograft. The surgical procedures were performed by one surgeon and reviewed at 1, 3, 6, and 12 months after surgery by an independent observer. Pterygium morphology was clinically graded as atrophic, intermediate, or fleshy according to an assessment of pterygium translucency. Risk factors were assessed using likelihood ratio tests. Weibull curves were used to estimate recurrence rates allowing for the interval censoring. In the group with primary pterygium (mean follow-up, 15.1 months), 38 (61%) of the 62 cases of bare sclera excision (heretofore referred to as the bare sclera group) had pterygium recur in contrast with 1 (2%) of the 61 cases of conjunctival autograft (heretofore referred to as the conjunctival autograph group) (P<.001, likelihood ratio X2 test). Nontranslucency, or fleshiness of the pterygium, and not age was a significant risk factor for recurrence in the bare sclera group (P<.001, likelihood ratio X2 test). In the group with recurrent pterygium (mean follow-up, 13.2 months), 14 (82%) of the 17 bare sclera group had pterygium recur, while no recurrences occurred among 17 cases in the conjunctival autograft group. Nontranslucency was again a highly significant factor for recurrence (P<.001, likelihood ratio X2 test). Pterygium recurrence is related to pterygium morphology and fleshiness of the pterygium is a significant risk factor for recurrence if bare sclera excision is performed. Conjunctival autografting for primary and recurrent pterygium is effective in reducing pterygium recurrence compared with bare sclera excision.
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            Sun exposure and pterygium of the eye: a dose-response curve.

            To present a quantitative analysis of pterygium and ocular sun exposure, a dose-response curve, and a discussion of the health-promotion implications of the findings. A hospital-based, case-control study was conducted in Perth, Western Australia. Case subjects had surgical removal of a pterygium; control subjects had an ear, nose, or throat procedure. A lifetime history of residence, sun exposure patterns, and use of hats, spectacles, and sunglasses was obtained at interview. Measures of potential sun exposure included latitude, daily sunshine hours, and daily global solar radiant energy. The most complex estimate of actual sun exposure was the daily ocular solar radiation dose, calculated from climatic data, time spent outdoors not under shade, and the use of hats and spectacles. There were strong positive associations between pterygium and measures of potential and actual sun exposure. Associations were as strong for whole-life measures as for those in any specific age range. Pterygium odds ratios increased with exposure level; the odds ratio was 4.0 (95% confidence interval, 1.6 to 10.9) for the highest quarter of the daily sun exposure. The strongest associations were seen for the estimated daily ocular solar radiation dose, with an odds ratio of 6.8 (95% confidence interval, 2.6 to 19.7) for the highest quarter of exposure. Pterygium is strongly related to ocular sun exposure, with little evidence that exposure during any particular period of life is more important than in other periods; the implication for prevention of pterygium is that ocular protection is beneficial at all ages.
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              UVB-mediated induction of interleukin-6 and -8 in pterygia and cultured human pterygium epithelial cells.

              Pterygia are common ocular surface lesions that are thought to be induced by exposure to ultraviolet (UV) radiation. The hypothesis tested in the current study is that UV radiation modulates the expression of interleukin (IL)-6 and -8, which could promote the neovascularization and chronic inflammation regularly observed in pterygia. Immunohistochemical analysis was performed on 10 pterygia and 14 specimens of normal conjunctiva (4 of which contained limbus), to identify the cellular source of these cytokines. Pterygium epithelial cells were exposed to UVB (0-100 mJ/cm(2)) and the expression of cytokine mRNA and protein was determined by reverse transcription-polymerase chain reaction (RT-PCR), RNase protection assay (RPA), and enzyme immunoassay. Similarly, pterygium tissue in organ culture was UVB irradiated and the supernatants analyzed for cytokine production. IL-6 and -8 proteins were abundantly expressed, predominantly by the pterygium epithelium, with additional IL-8 immunoreactivity associated with the vascular endothelium. In contrast, significantly less staining for both cytokines was observed in normal conjunctiva, cornea, and limbus. Expression of both IL-6 and -8 mRNA and protein was induced in UVB-irradiated pterygium epithelial cells in a time- and dose-dependent manner. Similarly, IL-6 and -8 proteins were significantly elevated in UVB-treated compared with nonirradiated pterygia. This study provides the first direct experimental evidence that implicates UV in the pathogenesis of pterygia. The two proinflammatory cytokines that are induced by UV radiation may play a key role in the development of pterygia, by initiating blood vessel formation, cellular proliferation, tissue invasion, and inflammation. Strategies aimed at reducing ocular exposure to UV light may decrease the incidence and recurrence of pterygia.
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                Author and article information

                Contributors
                650-713-7592 , drna@catholic.ac.kr
                Journal
                Lipids Health Dis
                Lipids Health Dis
                Lipids in Health and Disease
                BioMed Central (London )
                1476-511X
                20 November 2018
                20 November 2018
                2018
                : 17
                : 260
                Affiliations
                [1 ]ISNI 0000 0004 0470 4224, GRID grid.411947.e, Department of Pediatrics, Incheon St. Mary’s Hospital, College of Medicine, , The Catholic University of Korea, ; Incheon, South Korea
                [2 ]ISNI 0000 0004 0470 4224, GRID grid.411947.e, Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, , The Catholic University of Korea, ; Seoul, South Korea
                [3 ]ISNI 0000 0004 0470 4224, GRID grid.411947.e, Department of Ophthalmology, Yeouido St. Mary’s Hospital, College of Medicine, , The Catholic University of Korea, ; Seoul, South Korea
                Author information
                http://orcid.org/0000-0003-2708-7356
                Article
                902
                10.1186/s12944-018-0902-6
                6245817
                30453963
                ed190941-c52e-4499-9f16-c065cffac702
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 7 May 2018
                : 29 October 2018
                Funding
                Funded by: Catholic Medical Center Research Foundation (program year of 2016).
                Categories
                Research
                Custom metadata
                © The Author(s) 2018

                Biochemistry
                sun exposure,serum 25-hydroxyvitamin d,pterygium,large population-based study,epidemiology

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