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Medical hypothesis discovery and innovation in ophthalmology

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Bilateral Double-headed Recurrent Pterygium: A Case Presentation and Literature Review

  • Bengi Ece Kurtul
  • Ahmet Kakac
  • Abdulkerim Karaaslan

Medical hypothesis discovery and innovation in ophthalmology, Vol. 9 No. 2 (2020), 4 March 2020 , Page 85-90
Published 31 March 2020

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Abstract

Pterygium is a frequent corneal disease characterized by growing of fibrovascular tissue from the bulbar conjunctiva onto the cornea. Although the causes of pterygium are not obvious, sun exposure is closely correlated with its development. Pterygium, especially double-headed pterygium is mostly seen in warm climate and in individuals who work outdoors. A minority of pterygium is double-headed (both temporal and nasal origins). Bilateral recurrent double-headed pterygium is a very rare condition. Here, we reported a 35-year-old male patient with bilateral recurrent double-headed pterygium. A brief review about the recent literature concerning the etiology, associated risk factors, operation types and management of patients with recurrent pterygium was also discussed. The patient was a field worker, smoker and had a family history of pterygium. There was no ocular surgery history except pterygium surgery 15 years ago in both eyes. A successful pterygium excision was performed under local anesthesia with the vertical split conjunctival autograft transplantation (CAT) in both temporal and nasal parts of the right eye (randomly) for cosmetic disfigurement and avoidance of recurrence. The pathological report was consistent with pterygium. At postoperative first week, first and 1.5th month visits, conjunctival autografts were in place and stable. No complications such as infection, corneal thinning or graft dislocation were seen. The patient was satisfied with his right eye and demanded the same surgery for his left eye. We suggest vertical split simultaneous CAT as a safe and useful surgical method for the treatment of recurrent double-headed pterygium; however, longer follow-up is required to confirm the outcome.
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References

Otulana TO. Blindness and visual impairment in Remo, Ogun State, Nigeria: a hospital-based study. Niger Postgrad Med J. 2012;19(3):153-6. pmid: 23064171

Xu L, Jonas JB, Cui TT, You QS, Wang YX, Yang H, et al. Beijing Eye Public Health Care Project. Ophthalmology. 2012;119(6):1167-74. doi: 10.1016/j.ophtha.2011.11.036 pmid: 22406031

Elhamaky TR, Elbarky AM. Outcomes of Vertical Split Conjunctival Autograft Using Fibrin Glue in Treatment of Primary Double-Headed Pterygia. J Ophthalmol. 2018;2018:9341846. doi: 10.1155/2018/9341846 pmid: 30671262

Duman F, Kosker M. Demographics of Patients with Double-headed Pterygium and Surgical Outcomes. Turk J Ophthalmol. 2015;45(6):249-53. doi: 10.4274/tjo.56514 pmid: 27800243

Yeung SN, Rubenstein D, Price AJ, Elbaz U, Zhang AQ, Cote E, et al. Sequential pterygium excision with conjunctival autograft in the management of primary double-headed pterygia. Can J Ophthalmol. 2013;48(6):521-3. doi: 10.1016/j.jcjo.2013.05.014 pmid: 24314415

Aidenloo NS, Motarjemizadeh Q, Heidarpanah M. Risk factors for pterygium recurrence after limbal-conjunctival autografting: a retrospective, single-centre investigation. Jpn J Ophthalmol. 2018;62(3):349-56. doi: 10.1007/s10384-018-0582-9 pmid: 29549462

Lee JS, Ha SW, Yu S, Lee GJ, Park YJ. Efficacy and Safety of a Large Conjunctival Autograft for Recurrent Pterygium. Korean J Ophthalmol. 2017;31(6):469-78. doi: 10.3341/kjo.2016.0135 pmid: 29230976

Janson BJ, Sikder S. Surgical management of pterygium. Ocul Surf. 2014;12(2):112-9. doi: 10.1016/j.jtos.2014.01.001 pmid: 24725323

Wolter-Roessler E, Seitz B, Naumann GO. [Pterygoid corneal dystrophy]. Klin Monbl Augenheilkd. 2002;219(9):677-81. doi: 10.1055/s-2002-35166 pmid: 12410469

Chen T, Ding L, Shan G, Ke L, Ma J, Zhong Y. Prevalence and racial differences in pterygium: a cross-sectional study in Han and Uygur adults in Xinjiang, China. Invest Ophthalmol Vis Sci. 2015;56(2):1109-17. doi: 10.1167/iovs.14-15994 pmid: 25626966

Li Z, Wu S, Mai J, Xu K, Sun Y, Song Z, et al. Prevalence of and risk factors for pterygia in a rural Northern Chinese population. Ophthalmic Epidemiol. 2014;21(6):378-83. doi: 10.3109/09286586.2014.967359 pmid: 25300011

Jiao W, Zhou C, Wang T, Yang S, Bi H, Liu L, et al. Prevalence and risk factors for pterygium in rural older adults in Shandong Province of China: a cross-sectional study. Biomed Res Int. 2014;2014:658648. doi: 10.1155/2014/658648 pmid: 25165711

Nangia V, Jonas JB, Nair D, Saini N, Nangia P, Panda-Jonas S. Prevalence and associated factors for pterygium in rural agrarian central India. The central India eye and medical study. PLoS One. 2013;8(12):e82439. doi: 10.1371/journal.pone.0082439 pmid: 24324789

Liu L, Wu J, Geng J, Yuan Z, Huang D. Geographical prevalence and risk factors for pterygium: a systematic review and meta-analysis. BMJ Open. 2013;3(11):e003787. doi: 10.1136/bmjopen-2013-003787 pmid: 24253031

Altinkaynak H, Demircan A, Kocasarac C, Kara N, Dundar H, Altan C, et al. Effect of orbital protrusion and vertical interpalpebral distance on pterygium formation. Cont Lens Anterior Eye. 2014;37(3):153-6. doi: 10.1016/j.clae.2013.09.010 pmid: 24169502

Rezvan F, Hashemi H, Emamian MH, Kheirkhah A, Shariati M, Khabazkhoob M, et al. The prevalence and determinants of pterygium and pinguecula in an urban population in Shahroud, Iran. Acta Med Iran. 2012;50(10):689-96. pmid: 23275285

Li Z, Cui H. Prevalence and associated factors for pterygium in a rural adult population (the Southern Harbin Eye Study). Cornea. 2013;32(6):806-9. doi: 10.1097/ICO.0b013e31826dff30 pmid: 23086373

Cajucom-Uy H, Tong L, Wong TY, Tay WT, Saw SM. The prevalence of and risk factors for pterygium in an urban Malay population: the Singapore Malay Eye Study (SiMES). Br J Ophthalmol. 2010;94(8):977-81. doi: 10.1136/bjo.2008.150847 pmid: 19965830

Durkin SR, Abhary S, Newland HS, Selva D, Aung T, Casson RJ. The prevalence, severity and risk factors for pterygium in central Myanmar: the Meiktila Eye Study. Br J Ophthalmol. 2008;92(1):25-9. doi: 10.1136/bjo.2007.119842 pmid: 18055574

Lu J, Wang Z, Lu P, Chen X, Zhang W, Shi K, et al. Pterygium in an aged Mongolian population: a population-based study in China. Eye (Lond). 2009;23(2):421-7. doi: 10.1038/sj.eye.6703005 pmid: 17948037

Tan CS, Lim TH, Koh WP, Liew GC, Hoh ST, Tan CC, et al. Epidemiology of pterygium on a tropical island in the Riau Archipelago. Eye (Lond). 2006;20(8):908-12. doi: 10.1038/sj.eye.6702046 pmid: 16167080

Gazzard G, Saw SM, Farook M, Koh D, Widjaja D, Chia SE, et al. Pterygium in Indonesia: prevalence, severity and risk factors. Br J Ophthalmol. 2002;86(12):1341-6. doi: 10.1136/bjo.86.12.1341 pmid: 12446360

Wong TY, Foster PJ, Johnson GJ, Seah SK, Tan DT. The prevalence and risk factors for pterygium in an adult Chinese population in Singapore: the Tanjong Pagar survey. Am J Ophthalmol. 2001;131(2):176-83. doi: 10.1016/s0002-9394(00)00703-0 pmid: 11228292

Maharshak I, Avisar R. Bilateral primary pterygia: an occupational disease? Arch Environ Occup Health. 2009;64(2):137-40. doi: 10.3200/AEOH.64.2.137-140 pmid: 19395346

Akinsola FB, Mbadugha CA, Onakoya AO, Adefule-Ositelu AO, Aribaba OT, Rotimi-Samuel A. Pattern of conjunctival masses seen at Guinness Eye Centre Luth Idi-Araba. Nig Q J Hosp Med. 2012;22(1):39-43. pmid: 23175879

Malekifar P, Esfandiari H, Behnaz N, Javadi F, Azish S, Javadi MA, et al. Risk Factors for Pterygium in Ilam Province, Iran. J Ophthalmic Vis Res. 2017;12(3):270-4. doi: 10.4103/jovr.jovr_85_16 pmid: 28791059

Roka N, Shrestha SP, Joshi ND. Assessment of tear secretion and tear film instability in cases with pterygium and normal subjects. Nepal J Ophthalmol. 2013;5(1):16-23. doi: doi: 10.3126/nepjoph.v5i1.7816

3126/nepjoph.v5i1.7816 pmid: 23584641

Salustiano Correa ESR, de Pereira Avila M, Rassi AR, Ximenes L, da Silva DS, Jr., de Paula AC. Intra-operative use of 5-Fluorouracil in pterygium surgery: a comparative study. Semin Ophthalmol. 2013;28(1):34-6. doi: 10.3109/08820538.2012.730101 pmid: 23305439

Kareem AA, Farhood QK, Alhammami HA. The use of antimetabolites as adjunctive therapy in the surgical treatment of pterygium. Clin Ophthalmol. 2012;6:1849-54. doi: 10.2147/OPTH.S38388 pmid: 23152665

Huerva V, March A, Martinez-Alonso M, Muniesa MJ, Sanchez C. Pterygium surgery by means of conjunctival autograft: long term follow-up. Arq Bras Oftalmol. 2012;75(4):251-5. doi: 10.1590/s0004-27492012000400006 pmid: 23258655

Kobayashi A, Shirao Y, Segawa Y, Higashide T, Miwa S, Kawasaki K, et al. Multi-layer amniotic membrane graft for pterygium in a patient with xeroderma pigmentosum. Jpn J Ophthalmol. 2001;45(5):496-8. doi: 10.1016/s0021-5155(01)00404-x pmid: 11583672

Gonzalez Gomez A, Gonzalez de Gor Crooke JL, Garcia-Ben A, Garcia-Campos JM. Dellen and corneal perforation after bilateral pterygium excision in a patient with no risk factors. BMJ Case Rep. 2015;2015. doi: 10.1136/bcr-2015-213319 pmid: 26621907

Salagar KM, Biradar KG. Conjunctival autograft in primary and recurrent pterygium: a study. J Clin Diagn Res. 2013;7(12):2825-7. doi: 10.7860/JCDR/2013/7383.3767 pmid: 24551648

Fernandes M, Sangwan VS, Bansal AK, Gangopadhyay N, Sridhar MS, Garg P, et al. Outcome of pterygium surgery: analysis over 14 years. Eye (Lond). 2005;19(11):1182-90. doi: 10.1038/sj.eye.6701728 pmid: 15543190

Das S, Ramamurthy B, Sangwan VS. Deep lamellar keratoplasty for recurrent advanced pterygium. Ophthalmic Surg Lasers Imaging. 2009;40(1):43-5. doi: 10.3928/15428877-20090101-06 pmid: 19205495

Sudhalkar A. Fixation and its role in the causation, laterality and location of pterygium: a study in amblyopes and non-amblyopes. Eye (Lond). 2012;26(3):438-43. doi: 10.1038/eye.2011.322 pmid: 22157914

Ciftci S. Bilateral pterygium, symmetrical nodosity of the auricle, and free iris cyst. Can J Ophthalmol. 2009;44(6):713. doi: 10.3129/i09-141 pmid: 20029497

Demirok A, Cinal A, Yener HI, Yasar T, Kilic A. The risk factors of pterygium development: a hospital-based study. Ann Ophthalmol (Skokie). 2008;40(2):103-6. pmid: 19013918

Yalcin Tok O, Burcu Nurozler A, Ergun G, Akbas Kocaoglu F, Duman S. Topical cyclosporine A in the prevention of pterygium recurrence. Ophthalmologica. 2008;222(6):391-6. doi: 10.1159/000151740 pmid: 18765950

Ukponmwan CU, Dawodu OA, Edema OF, Okojie O. Prevalence of pterygium and pingueculum among motorcyclists in Nigeria. East Afr Med J. 2007;84(11):516-21. doi: 10.4314/eamj.v84i11.9570 pmid: 18303743

Taylor SL, Coates ML, Vallejos Q, Feldman SR, Schulz MR, Quandt SA, et al. Pterygium among Latino migrant farmworkers in North Carolina. Arch Environ Occup Health. 2006;61(1):27-32. doi: 10.3200/AEOH.61.1.27-32 pmid: 17503618

Molho-Pessach V, Mechoulam H, Siam R, Babay S, Ramot Y, Zlotogorski A. Ophthalmologic Findings in H Syndrome: A Unique Diagnostic Clue. Ophthalmic Genet. 2015;36(4):365-8. doi: 10.3109/13816810.2014.886272 pmid: 24547910

Emmert S, Ueda T, Zumsteg U, Weber P, Khan SG, Oh KS, et al. Strict sun protection results in minimal skin changes in a patient with xeroderma pigmentosum and a novel c.2009delG mutation in XPD (ERCC2). Exp Dermatol. 2009;18(1):64-8. doi: 10.1111/j.1600-0625.2008.00763.x pmid: 18637129

Goyal JL, Rao VA, Srinivasan R, Agrawal K. Oculocutaneous manifestations in xeroderma pigmentosa. Br J Ophthalmol. 1994;78(4):295-7. doi: 10.1136/bjo.78.4.295 pmid: 8199117

Hecht F, Shoptaugh MG. Winglets of the eye: dominant transmission of early adult pterygium of the conjunctiva. J Med Genet. 1990;27(6):392-4. doi: 10.1136/jmg.27.6.392 pmid: 2359104

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ISSN: 2322-3219

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