New approaches to the diagnosis and treatment of pterygium

Relevance Pterygium is a common disease in which fibrovascular tissue from the conjunctiva grows onto the cornea [1]. Its prevalence ranges from 0.7 to 31%, which negatively affects vision and quality of life [2]. At an early stage, it is asymptomatic and is a cosmetic defect. As it progresses, itching, redness and a foreign body sensation occur. The tissue growth disrupts the lacrimal coating, causing dry eyes [3]. Biomicroscopy allows you to examine the ocular surface, identifying three parts of the pterygium: the visor, the head, and the body/tail. OCT allows you to study changes in the cornea and pterygium, assessing activity and growth. Signs of progression are a decrease in the thickness of the cornea and newly formed vessels. During diagnostics, the Scheimpflug camera (Pentacam) calculates the parameters of the cornea and the anterior chamber of the eye. Pterygium (grade II–IV) causes flattening of the cornea and may lead to astigmatism [4]. Confocal microscopy is used to study the structures of epithelial cells, stroma, and endothelium of the cornea. The Schirmer test showed that pterygium changes the qualitative composition of the tear film, revealing III and IV types of crystallization according to M. Rolando, which indicates a lack of mucin [5]. Objective Determination of accurate methods for diagnosing and treating pterygium. Material and methods The study included patients with pterygium of different degrees. Research methods: biomicroscopy, Scheimpflug camera (Pentacam), OCT, confocal microscopy, Schirmer test. Treatment methods: tear substitutes, wearing sunglasses. With pterygium progression to grade II–V and frequent relapses – surgical treatment with complete/partial excision of the pterygium. Recurrence rate is 1.9–89% of cases. The “gold standard” is excision followed by autoplasty with a free conjunctival flap. The method is characterized by a lower (1.9–40%) recurrence rate. Adjuvant therapy in combination to reduce the risk of recurrence. Results Clinical signs have been systematized and algorithms for the diagnosis and surgical treatment of pterygium have been developed. The results are presented in the form of diagrams of sequential actions, which will facilitate diagnosis and treatment tactics. Conclusion Timely diagnosis is critically important for solving the problem of pterygium. To achieve better treatment results, it is necessary to continue studying the pathogenetic mechanisms of the disease using modern diagnostic methods. Key words: pterygium; OCT; dry eye syndrome; confocal microscopy; Pentacam; Schirmer test; ORA