yulia pterygium.ppt
TRANSCRIPT
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PERTUMBUHAN JARINGAN FIBROVASKULER BERBENTUK SEGITIGA DENGAN APEKS SELALU DI KORNEABERSIFAT DEGENERATIF DAN INVASIF
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MUTASI GEN P53 MENURUNKAN APOPTOSISMENINGKATKAN TGF-bLIMBAL STEM CELL DEFFICIENCY
PAPARAN UVPAPARAN ANGINPAPARAN DEBUKELEMBABAN UDARA YG KURANGDRY EYE SYNDROME
PTERYGIUM
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Elastotic degeneration fragmentation and breakdown of stromal collagen
Destruction of Bowmans layer by advancing fibrovascular tissue resulting in corneal scarring
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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).
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Goblet cell hyperplasia is apparent in pterygium (B), compared with donor-matched conjunctiva (C).
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Prominent central feeder vessel; inset shows dilated subepithelial vessels
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E: Elastotic changes (double asterisk) in pterygium stroma. F: Inflammatory infiltrates in the epithelium. G: Stromal vessels loaded with polymorphonuclear leukocytes.
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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
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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**
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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)
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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**
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Reported recurrence rates are variable (between 0 40 %) Few complicationsFurther prospective studies in primary and recurrent pterygia are needed