Scientific Online Resource System

Scripta Scientifica Medica

Microstructural evidence of the anterior ocular surface alteration in patients with pterygium

Vesela Ivancheva, Teodora Marinova, Valeri Sheherov, Christina Grupcheva


Purpose: To study microstructural changes in cornea and conjunctiva of patients with pterygium using in vivo laser scanning confocal microscopy (LSCM).

Methods: Seventy eyes of 64 patients with pterygium and 70 eyes of 70 healthy subjects were examined. Using LSCM in vivo images at microstructural level were captured. The density of keratocytes in the anterior and posterior stroma and basal corneal epithelial cells and the density of specific cellular structures of the pterygium were calculated. Comparative analysis of the central cornea and nasal bulbar conjunctiva of the control subjects was performed.

Results: Density of basal corneal epithelial cells and anterior keratocytes in corneas with pterygium was determined at: 4678±41 cells/mm² and 424±17 cells/mm² respectively, which was lower than that in the controls. Dendritic cells with density 115±11 cells/mm² were found in regions of pterygia. The dendritic cell density in the pterygium was found higher than the density in the nasal bulbar conjunctiva of the healthy eyes. Morphologic alterations of the sub-basal nerve plexus were observed in pterygium, as well as bright deposits at the level of the basal epithelial layer and also hyperreflective spots in the surface epithelium, corresponding to the clinically observed Fuchs` flecks.

Conclusions: In vivo LSCM is method of choice for dynamic evaluation of the morphologic alterations of pterygium, allowing precise diagnosis, prognosis and monitoring of this disease. Study highlighted microstructural alterations and increased dendritic cells presumed to be characteristic of pterygium and adjacent to it clear cornea.


Pterygium; confocal microscopy; cornea

Full Text


Yanoff M, Jay S. Duker, James J. Augsburger Ophthalmology 2nd edition, Sep 2003

Yan Wang, Feng Zhao, Wenqing Zhu, Jianjiang XU, Tianyu Zheng, Xinnghuai Sun In Vivo Confocal Microscopic Evaluation of Morphologic Changes and Dendritic Cell Distribution in Pterygium. American Journal of Ophthalmology Vol 150, No. 5, 2010

Papadia M, Barabino S, Rolando M. In vivo confocal microscopy in a case of pterygium. Ophthalmic Surg Lasers Imaging; 39(6):511-513, 2008

Papadia M, Barabino S, Valente C, Rolando M. Anatomical and immunological changes of the cornea in patients with pterygium. Curr Eye Res; 33(5):429-434, 2008

Zhivov A, Beck R, Guthoff RF. Corneal and conjunctival findings after mitomycin C application in pterygium surgery: an in-vivo confocal microscopy study. Acta Ophthalmol; 87(2):166 -172, 2009

Jeanie Chui, Minas T. Coroneo, Lien T. Tat, Roger Crouch, Denis Wakefield, and Nick Di Girolamo Ophthalmic Pterygium:A Stem Cell Disorder with Premalignant Features. The American Journal of Pathology, Vol. 178, No. 2, Feb 2011

Nebil Bal, Fazilet Kayaselcuk, Aysel Pelat, Filiz Bolat, Beyhan Demarhan, Mast cell density in pterygium, and its association with ultraviolet exposure in different climatic conditions: A series of 140 cases Turkish Journal of Pathology 22(1):11- 16, 2006

Beden U, Irkeç M, Orhan D, Orhan M. The roles of T-lymphocyte subpopulations (CD4 and CD8), intercellular adhesion molecule-1 (ICAM-1), HLADR receptor, and mast cells in etiopathogenesis of pterygium. Ocul Immunol Inflamm 2003;11(2):115-122.

Gillette TE, Chandler JW, Greiner JV. Langerhans cells ofthe ocular surface. Ophthalmology 89(6):700 -711, 1982

Di Girolamo N, Chui J, Coroneo MT, Wakefield D. Pathogenesis of pterygia: role of cytokines, growth factors, and matrix metalloproteinases. Prog Retin Eye Res 23(2):195-228, 2004

Bradley JC, Yang W, Bradley RH, Reid TW, Schwab IR. The science of pterygium. Br J Ophthalmol 2009 June 9.

Thaer S. Alomar, Mario Nubile, James Lowe, Harminder S. Dua. Corneal Intraepithelial Neoplasia: In Vivo Confocal Microscopic Study With Histopathologic Correlation. Am J Ophth Vol. 151, No. 2,Feb 2011

Zheng T, Xu J. Age-related changes of human limbus on in vivo confocal microscopy. Cornea 27(7):782-786, 2008

Coroneo MT. Pterygium as an early indicator of ultraviolet insolation: a hypothesis. Br J Ophthalmol 77(11):734-739, 1993

Mustonen RK, McDonald MB, Srivannaboon S, Tan AL, Doubrava MW, Kim CK. Normal human corneal cell populations evaluated by in vivo scanning slit confocal microscopy. Cornea 17(5):485- 492, 1998

Bonini S, Rama P, Olzi D, Lambiase A. Neurotrophic keratitis. Eye (Lond) 17(8):989 -995, 2003

Araki K, Ohashi Y, Kinoshita S, Hayashi K, Kuwayama Y, Tano Y. Epithelial wound healing in the denervated cornea. Curr Eye Res 13(3):203-211, 1994

Article Tools
Email this article (Login required)
About The Authors

Vesela Ivancheva
Medical University of Varna

Department of Ophthalmology and Visual Science

Teodora Marinova
Medical University of Varna

Department of Ophthalmology and Visual Science, Medical University of Varna, Specialised Eye Hospital - Varna

Valeri Sheherov
Medical University of Varna

Department of Ophthalmology and Visual Science, Medical University of Varna, Specialised Eye Hospital - Varna

Christina Grupcheva
Medical University of Varna

Department of Ophthalmology and Visual Science, Medical University of Varna, Specialised Eye Hospital - Varna

Font Size