Faculty of Medicine
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Item type:Publication, Евалуација на трансплантационите техники на хируршко лекување на птеригиу и хистоморфолошка проценка на ризик од рецидив - докторска дисертација(2012)Pterygium as an active invasive inflammatory process, a key feature of which is focal limbal failure. The pterygium is a long term and recurrent illness, one that leads to permanent decrease of the visual acuity and anterior segment. Due to the inefficient prophylaxis and the frequent postoperative recurrence, the pterygium is still an intriguing problem in ophthalmology. The aim of the research was to evaluate the success rate of the surgical excision of pterygium with modification of the reconstructive method of liberal conjunctival auto transplantation with grаft from the inferior temporal bulbar conjunctiva, while at the same time to define the advantages and disadvantages of the same, compared to the method of liberal conjunctival auto transplantation with graft from the superior temporal bulbar conjunctiva. The correlation between the stationary and progressive primary pterygium and recurrent pterygium, was determined histopathologically and immunohistochemically by evaluating the fibroblastic proliferation, the degenerative changes of the connective tissue, the angiogenesis, the chronic inflammatory infiltration, the elastosis and the metaplasia of the conjunctival epithelium. Histomorphologically, the structure of the primary pterygia in stationary and progressive stadium, recurrent pterygium and healthy conjunctiva was evaluated. The tear film at the primary stationary and progressive pterygium, and the recurrent pterygium, was evaluated before and postoperative. In the prospective-retrospective study two groups of patients with primary stationary (60 patients) and progressive pterygium (60 patients) were compared, both surgically treated with two different refractive surgical methods of liberal conjunctival auto transplantation with graft from the inferior temporal or superior temporal bulbar conjunctiva. Also, a group of patients (30 patients) with recurrent pterygium was examined and treated with the modified conjunctival auto transplantation with graft from the inferior temporal bulbar conjunctiva. The surgeries were performed at the University Eye Clinic within the Medical Faculty – UKIM in Skopje in the periods of January 2001 to December 2003 and January 2009 to April 2011. The patients were continually followed before and post operatively with Haag-Streit 900 slit lamp to measure the size of the pterygium and to discover its subjective and objective complications and their nature, as well as the incidence of occurrence. Using the Snellen optotype the uncorrected visual acuity before and postoperatively was determined. Furthermore, before and postoperatively the corneal astigmatism was followed with a Javal keratometer and an auto refractometer. Before and postoperatively, the patients were photographed with Topcon Red Camera in the FFA Cabinet at the Eye Clinic. With standard tests for examination of the tear film before and post operatively are followed the patients (90 patients) operated with the modified conjunctival auto transplantation with graft from the inferior bulbar conjunctiva, as well at the Eye Clinic in the period of January 2009 to May 2011. The representative sample of pterygium and healthy conjunctiva were histopathologically, histochemically and immunohistochemically examined at the Institute of Pathology within the Medical Faculty in Skopje in the period of January 2009 to June 2011. A smaller number of early subjective and objective postoperative complications, better visual acuity, decrease of the postoperative astigmatism and smaller number of postoperative recurrence were distinguished at the patients operated with the modified surgical method with graft from the inferior temporal bulbar conjunctiva. Based on the results, the statistical research, as well as on the discussion, the following conclusions were drawn: 1. The modified surgical method with graft from the inferior temporal bulbar conjunctiva proves to be the most successful surgical method for primary stationary and progressive pterygia, as well as recurrent pterygia, based on the following advantages: a) insignificant subjective and objective postoperative complications; b) improvement of the postoperative visual acuity; c) small frequency of recurrence; d) postoperative improvement of the tear functions and the tear film; e) safe, efficient and affordable surgical method; f) outstanding esthetic results; g) preservation of the superior bulbar conjunctiva for future surgical interventions especially recommended for the glaucoma patients. 2. The intensity of the inflammation, the angiogenesis and the degenerative changes, were noted more at the primary progressive and the recurrent pterygia, and are also in correlation with the structure of the pterygium that helps predict the postoperative recurrence and the evolutionary stadium of the pterygium. 3. The correlation between the pterygium and low stability of the tear film was clearly shown by the tear film test results. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Evaluation of the tear film in eyes with pterygium and after its surgical excision using the limbal inferior-lateral conjunctival autotransplantation procedure(2010)Aim To determine the eventual abnormalities of the tear function at patients with unilateral pterygium and after its surgical excision using conjunctival autotransplantation from the limbal inferior-lateral conjunctiva. Method The tear function was examined on 60 patients with unilateral pterygium before and after surgical excision of the pterygium with conjunctival autotransplantation using the graft from the limbal inferior-lateral conjunctiva. Schirmer test with and without local anesthetic and the break-up time of the tear film were used on the healthy eye, the eye with pterygium and after the pterygium surgery on the same patient. Results The mean time of the tear film break-up time (BUT) is 13,4 sec (10,7 sec - 16,2 sec) on the healthy eye. This mean time was significantly shorter, 5,6 sec (9,7 sec ± 4,7 sec), in the same patients but measured at the eye with pterygium. After 1 month of the operation and excision of the pterygium the mean time of the BUT was significantly longer (11,7sec ± 2,7 sec). Measured by the Schirmer test, the size of the wet area on the Whatman filter paper with local anesthesia was 14mm (12mm - 16mm) on the healthy eye and 4,5mm (3,0mm - 6,0mm) on the eye with pterygium. Postoperatively, the size of the wet area increased, i.e. the area was 14,8mm (12,7mm – 16,9mm). The wet area’s size measured by the Schirmer test without local anesthesia before the surgery of pterygium was 4,80 mm (3,50 mm - 6,1mm), after the surgery 15,50mm (13,5mm -17,50mm) and on the healthy eye 16mm (15,0mm-17,0mm). Conclusion The tear function in patients with primary pterygium improves after its surgical excision with the conjunctival autotransplantation using the graft from the limbal inferior-lateral conjunctiva. Thus it can be concluded that pterygium has a close relationship with the dryness of the eye. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, COMPARATIVE STUDY OF PTERYGIUM SURGERY(2004)Aim: To evaluate the success rates of surgical techniques for primary pterygium-pterygium excision with conjunctival autograft transplantation and pterygium excision with complete suture of conjunctiva without transplantation Methods: 75 cases with primary pterygium were prospectively reviewed. Outcome was evaluated in terms of recurrence of pterygia onto the cornea. The patients were divided into 2 groups: 40 eyes were operated with recurrence of pterygia onto the cornea. The patients were divided into 2 groups:40 eyes were operated with conjunctival autograft transplantation (20 cases by pterygium invades the cornea 3mm and 20 cases by pterygium invades the cornea 3mm and more).35 cases were operated by pterygium with complete suture of conjunctivae without transplantation (20 cases by pterygium invading the cornea 3mm and 15 cases by pterygium invading the corneae 3mm and more) Results:Mean follow up was 12 months (2-24 months) 4 out of 40 recur (10%) after the conjunctival autograft transplantation, while 14 of 35 cases recur (40%) after the pterygium excision with complete suture of conjunctiva without transplantation.One surgeon performed the surgery. Conclusion: Conjunctival autografts in pterygia have excellent efficacy against recurrence within the first year. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, PTERYGIUM-a case report(2006); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Pterygium excision with limbal autograft transplantation and its histopathological caracteristics of the epithelium(2015); ; INTRODUCTION: Pterygium is a chronic fibro vascular and degerenative process and originates from the basal limbal stem cells. AIM: The eximination of morphology and cytoceratin expresion of the epithelium of primary stationary and progressive pterygium. Also the method of pterygium excision with limbal autographt transplantation was evaluated. The post operative complications as recidives were evaluated. MATHERIAL AND METHOD: Impression cytology and imunohistohemical staining with antikeratin antibodies were performed in 140 eyes with pterygium. The pterygium was surgically excised using the limbal grapht from imferior or superior bulbar conjunctiva. Avidin – Biotin (ABC and LSAB) technique was performed for the imuno histochemical investigation of the tissue slides of pterygium on Poly-L-lysine-glasses. RESULTS: There were epithelial diversity in the tissues slides of primary stationary and progressive pterygium. Diversity of epithelium was found between the different cuts of the same pterygium depending which part of the pterygium was examined. The areas of squamous epithelial prone to keratinisations was relatively frequent. Also there were areas of erosion and even dysplastic areas. Goblet cells were found isolated or associated and were intensively PAS positive. The post operative incidence of recidivating pterygium was 7%. CONCLUSION: Pterygium shows significant changes in the epithelium even in the different slides of the same pterygium and its not associated with the stadium of the primary pterygium. Pterygium excision with limbal autographt transplantation is a surgical method of choice for primary stationary and progressive pterygium. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Angiogenesis in pterygium: histopathological and imunohistochemical study(2016); Pterygium is an active invasive inflammatory process, a key feature of which is focal limbal failure. It is a triangular conjunctival-epithelial overgrowth covering the cornea, a long term and recurrent illness that leads to permanent decrease of the visual acuity and esthetic changes of the eye’s anterior segment. Aim: The correlation between the stationary and progressive primary pterygium and recurrent pterygium was determined histo pathologically and immunohistochemically using the CD31 and CD34 antibodies for the identification of the vascular endothelium and micro density, i.e. angiogenesis in the pterygium tissue after pterygium excision with conjunctival autograft transplantation from the inferior bulbar conjunctiva. Material and methods: This study compares two groups of primary pterygium, stationary pterygium (30 patients) and progressive pterygium (30 patients), and one group of recurrent pterygium (30 patients), that were surgically treated with refractive surgical method of pterygium excision with conjunctival autograft transplantation from the inferior bulbar conjunctiva. In the period of 2009 to 2011, the surgeries were performed at the University Eye Clinic, while the histopathological and immuno histochemical study was performed at the Institute of Pathology using CD31 and CD34 antibodies for the angiogenesis identification. Results: No statistically significant difference was found in the vascular angiogenesis between the progressive and recurrent pterygium (Z=-0,258 p=0,7958), however statistically significant difference was found in the vascular angiogenesis between the stationary and either progressive (Z=-3,770 p=0,00016) or recurrent (Z=-3,866 p=0,00011) pterygium (using Mann-Whitney U Test). Conclusion: The higher developed angiogenesis in both primary progressive and recurrent pterygium, may support previous suggestions that angiogenesis may play a role in the formation of pterygia and its postoperative recurrence. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, A sporadic case of bilateral nasal and temporal pterigia on both eyes-case report(2017); A rare case of bilateral nasal and temporal pterygium is presented in the study. All four pterygia were operated with limbal conjunctival auto transplantation from superior or inferior part of the bulbar conjunctiva. There was no recurrence. Samples of the surgery excised pterygium tissue were patohistologicaly examined. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, COMPARATIVE STUDY OF PTERYGIUM SURGERY(Macedonian Academy of Sciences and Arts, 2011); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, A sporadic case of bilateral nasal and temporal pterygium on both eyes(2018); A rare case of bilateral nasal and temporal pterygium is presented in the study. All four pterygia were operated with limbal conjunctival auto transplantation from superior or inferior part of the bulbar conjunctiva. There was no recurrence. Samples of the surgery excised pterygium tissue were pathohistologicaly examined - Some of the metrics are blocked by yourconsent settings
Item type:Publication, A comparative study of visual acuity before and after pterygium excision by conjunctival autotransplantation techniques(Faculty of Medicine, University Ss. Cyril and Methodius in Skopje, 2020)Purpose: To evaluate the visual acuity and corneal astigmatismus preoperatively and after the excision of pterigia by conjunctival auto transplantation techniques. Material and methods: 120 patients were divided in two groups of 60 patients depending of the used surgical methods. A group of 60 patients (group No.1) treated by the technique of pterygium excision with the conjunctival auto graft transplantation with graft from the inferior temporal bulbar conjunctivae (ITBC) and a group of 60 patients (group No.2) treated by the technique of pterygium excision with the conjunctival auto transplantation with graft from the superior temporal bulbar conjunctivae (STBC). The both groups were subdivided on two groups, a group of 30 patients with stationery pterygium and 30 patients with progressive pterygium. Preoperatively and postoperatively, all patients were assessed for visual acuity, anterior and posterior segments, autorefraction, and autokeratometry. Results: In 76,6% of the patients from the group No.1 and in 60% of the patients from the group No.2 with stationary pterygium the postoperative visual acuity was significantly better with no statistical significant difference between the groups (p=0,1724). In 86,6% of the patients from the group No.1 and in 63,3 % of the patients from the group No.2 with progressive pterygium, the postoperative visual acuity was significantly better with no statistical significant difference between the groups (p=0,1417). Conclusion: Pterygium excision with conjunctival auto transplantation procedures (STBC and ITBC) results in significant reduction in astigmatism which leads to improvement in visual acuity.