Pterygium Is a Pre-Malignant Condition: A Systematic Review
Pterygium: A Pre-Malignant Condition
DOI:
https://doi.org/10.54393/pjhs.v6i12.3495Keywords:
Ultraviolet Radiations, Limbus, Pterygium, Ocular Surface Neoplasia, Conjunctival Intra-Epithelial Neoplasia, Squamous Cell CarcinomaAbstract
In a hot and humid climate Pterygium is one of the common ocular surface disorders. The ultraviolet radiations have been implicated in the pathogenesis of this condition. Objectives: To investigate the association between pterygium and ocular surface squamous neoplasia (OSSN) and to determine the prevalence rates of both diseases in varied populations worldwide. Methods: The internet search in the selected databases resulted in 420 articles in the first round. The second round of screening of the titles excluded 26 articles ascribed to be duplicates. The third round of evaluation ended with the exclusion of 341 articles because they lacked an association between the pterygium and OSSN. In the final round, 29 studies were excluded according to the inclusion and exclusion criteria. Results: A total of 12492 pterygia samples were reported in 24 studies. Most of the studies had been conducted in hot and temperate climates. Out of these twenty-four, three studies were from areas of low UV Radiation like Canada, while six were from the USA, three were from South America, four studies were from Australia and New Zealand, three were from Europe, and one each was from South East Asia, the Middle East, and Far East Asia and Africa. Conclusions: There is a paucity of homogeneity in the reported data on the correlation of pterygium and OSSN. Such studies will delineate the relationship between patients with pterygium and suspected OSSN and will provide predictive information to care for public health issues in these countries.
References
Chui JJ and Coroneo MT. Pterygium Pathogenesis, Actinic Damage, and Recurrence. In Pterygium. 2024 Jun: 1-26. doi: 10.1201/9781003526094-1.
Taylor HR, West SK, Rosenthal FS, Munoz B, Newland HS, Emmett EA. Corneal Changes Associated with Chronic UV Irradiation. Archives of Ophthalmology. 1989 Oct; 107(10): 1481-4. doi: 10.1001/archopht.1989.01070020555039.
Martín-López J, Pérez-Rico C, Benito-Martínez S, Pérez-Köhler B, Buján J, Pascual G. The Role of the Stromal Extracellular Matrix in the Development of Pterygium Pathology: An Update. Journal of Clinical Medicine. 2021 Dec; 10(24): 5930. doi: 10.3390/jcm10245930.
Alkatan HM, Alshomar KM, Helmi HA, Alhothali WM, Alshalan AM. Conjunctival Lesions: A 5-Year Basic Demographic Data and Clinicopathological Review in a Tertiary Eye Care Hospital. Journal of Epidemiology and Global Health. 2022 Mar; 12(1): 25-39. doi: 10.1007/s44197-021-00017-1.
Hӧllhumer R, Williams S, Michelow P. Ocular Surface Squamous Neoplasia: Management and Outcomes. Eye. 2021 Jun; 35(6): 1562-73. doi: 10.1038/s41433-021-01422-3.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. British Medical Journal. 2021 Mar; 372.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. Updating Guidance for Reporting Systematic Reviews: Development of the PRISMA 2020 Statement. Journal of Clinical Epidemiology. 2021 Jun; 134: 103-12. doi: 10.1016/j.jclinepi.2021.02.003.
Sevel D and Sealy R. Pterygia and Carcinoma of the Conjunctiva. Transactions of the Ophthalmological Societies of the United Kingdom. 1969; 88: 567-78.
Clear AS, Chirambo MC, Hutt MS. Solar Keratosis, Pterygium, and Squamous Cell Carcinoma of the Conjunctiva in Malawi. British Journal of Ophthalmology. 1979 Feb; 63(2): 102-9. doi: 10.1136/bjo.63.2.102.
Erie JC, Campbell RJ, Liesegang TJ. Conjunctival and Corneal Intraepithelial and Invasive Neoplasia. Ophthalmology. 1986 Feb; 93(2): 176-83. doi: 10.1016/S0161-6420(86)33764-3.
Hirst LW, Axelsen RA, Schwab I. Pterygium and Associated Ocular Surface Squamous Neoplasia. Archives of Ophthalmology. 2009 Jan; 127(1): 31-2. doi: 10.1001/archophthalmol.2008.531.
Chui J, Coroneo MT, Tat LT, Crouch R, Wakefield D, Di Girolamo N. Ophthalmic Pterygium: A Stem Cell Disorder with Premalignant Features. The American Journal of Pathology. 2011 Feb; 178(2): 817-27. doi: 10.1016/j.ajpath.2010.10.037.
Yeung SN, Kim P, Lichtinger A, Amiran MD, Cote E, Teitel S et al. Incidence of Ocular Surface Squamous Neoplasia in Pterygium Specimens: An 8-Year Survey. British Journal of Ophthalmology. 2011 Apr; 95(4): 592-. doi: 10.1136/bjo.2010.197491.
Galor A, Karp CL, Oellers P, Kao AA, Abdelaziz A, Feuer W et al. Predictors of Ocular Surface Squamous Neoplasia Recurrence After Excisional Surgery. Ophthalmology. 2012 Oct; 119(10): 1974-81. doi: 10.1016/j.ophtha.2012.04.022.
McClellan AJ, McClellan AL, Pezon CF, Karp CL, Feuer W, Galor A. Epidemiology of Ocular Surface Squamous Neoplasia in A Veterans Affairs Population. Cornea. 2013 Oct; 32(10): 1354-8. doi: 10.1097/ICO.0b013e31829e3c80.
Oellers P, Karp CL, Sheth A, Kao AA, Abdelaziz A, Matthews JL et al. Prevalence, Treatment, and Outcomes of Coexistent Ocular Surface Squamous Neoplasia and Pterygium. Ophthalmology. 2013 Mar; 120(3): 445-50. doi: 10.1016/j.ophtha.2012.08.010.
Artornsombudh P, Sanpavat A, Tinnungwattana U, Tongkhomsai V, Sansopha L, Tulvatana W. Prevalence and Clinicopathologic Findings of Conjunctival Epithelial Neoplasia in Pterygia. Ophthalmology. 2013 Jul; 120(7): 1337-40. doi: 10.1016/j.ophtha.2012.12.020.
Segev F, Mimouni M, Tessler G, Hilely A, Ofir S, Kidron D et al. A 10-Year Survey: Prevalence of Ocular Surface Squamous Neoplasia in Clinically Benign Pterygium Specimens. Current Eye Research. 2015 Dec; 40(12): 1284-7. doi: 10.3109/02713683.2014.993086.
Barros JD, Lowen MS, Moraes-Filho MN, Martins MC. Use of Impression Cytology for the Detection of Unsuspected Ocular Surface Squamous Neoplasia Cells in Pterygia. Arquivos Brasileiros De Oftalmologia. 2014 Oct; 77(5): 305-9. doi: 10.5935/0004-2749.20140077.
Zoroquiain P, Jabbour S, Aldrees S, Villa N, Bravo-Filho V, Dietrich H et al. High Frequency of Squamous Intraepithelial Neoplasia in Pterygium Related to Low Ultraviolet Light Exposure. Saudi Journal of Ophthalmology. 2016 Apr; 30(2): 113-6. doi: 10.1016/j.sjopt.2016.02.007.
Detorakis ET, Kymionis G, Tsatsos M, Spandidos DA. Pterygium Concomitant with Other Ocular Surface Lesions: Clinical Implications and Pathogenetic Links. Experimental And Therapeutic Medicine. 2016 Jan; 11(1): 69-72. doi: 10.3892/etm.2015.2865.
Mendoza PR, Craven CM, Ip MH, Wilson MW, Coroneo MT, Grossniklaus HE. Conjunctival Squamous Cell Carcinoma with Corneal Stromal Invasion in Presumed Pterygia: A Case Series. Ocular Oncology and Pathology. 2018 Jun; 4(4): 240-9. doi: 10.1159/000485425.
Hung KH, Hsiao CH, Tan HY, Chen HC, Ma DH, Lin HC et al. Clinical Demographics of Pterygium Excision and Prevalence of Conjunctival Intraepithelial Neoplasia: A 15-Year Review. International Ophthalmology. 2020 Jul; 40(7): 1781-8. doi: 10.1007/s10792-020-01347-y.
Lomelí-Linares D, García-Salgado L, Riancho-Sánchez G, Lopez-Star E, Lansingh VC, Corredor-Casas S. Frequency of Conjunctival Epithelial Dysplasia in Patients with Pterygium. Arquivos Brasileiros de Oftalmologia. 2020 Jul; 83(4): 323-8. doi: 10.5935/0004-2749.20200053.
Mejia LF, Zapata M, Gil JC. An Unexpected Incidence of Ocular Surface Neoplasia on Pterygium Surgery. A Retrospective Clinical and Histopathological Report. Cornea. 2021 Aug; 40(8): 1002-6. doi: 10.1097/ICO.0000000000002586.
Bergeron S, Ito H, Dossous YE, Burnier Jr MN. Histopathological Variability and Concomitant Lesions in Pterygium in A Large Case Series. Journal of Ophthalmology. 2021; 2021(1): 6623794. doi: 10.1155/2021/6623794.
Suren E, Nergiz D, Süren D, Alikanoğlu AS, Yıldırım HT, Altun ZA. Expression of p16 in Pterygium and Its Relation with Epithelial Dysplasia and Possible Etiologic Role of HPV. Indian Journal of Pathology and Microbiology. 2022 Apr; 65(2): 258-61. doi: 10.4103/IJPM.IJPM_1152_20.
Modabber M, Lent-Schochet D, Li JY, Kim E. Histopathological Rate of Ocular Surface Squamous Neoplasia in Clinically Suspected Pterygium Specimens: 10-Year Results. Cornea. 2022 Feb; 41(2): 149-54. doi: 10.1097/ICO.0000000000002780.
Zhu C, Weiss M, Scribbick FW, Johnson DA, Kheirkhah A. Occurrence of Occult Neoplasia in Pterygium Specimens among Hispanic and Non-Hispanic Patients. Current Eye Research. 2022 Jul; 47(7): 978-81. doi: 10.1080/02713683.2022.2035403.
Hossain RR, Oh JA, McLintock C, Murphy C, McKelvie J. Ocular Surface Squamous Neoplasia: A 12-Month Prospective Evaluation of Incidence in Waikato, New Zealand. Vision. 2022 Aug; 6(3): 50. doi: 10.3390/vision6030050.
Quhill H, Magan T, Thaung C, Sagoo MS. Prevalence of Co-Existent Neoplasia in Clinically Diagnosed Pterygia in a UK Population. Eye. 2023 Dec; 37(18): 3757-61. doi: 10.1038/s41433-023-02594-w.
Yang Y, Bachour K, Tong M, Khair D, Gaffar J, Robert MC et al. Incidence of Ocular Surface Squamous Neoplasia in Pterygium Specimens. Canadian Journal of Ophthalmology. 2024 Apr; 59(2): 79-82. doi: 10.1016/j.jcjo.2022.12.004.
S Vempuluru V, Heroor A, Chheda PP, Patil G, Vatte B, Kaliki S. Ocular Surface Squamous Neoplasia with Coexistent Pterygia: A Study of 14 Cases and Review of Literature. InSeminars in Ophthalmology. 2025 Oct; 40(7): 59-667. doi: 10.1080/08820538.2024.2346748.
Mihalache A, Huang RS, Balas M, Bert B, Do RY, Hsu H et al. Incidental Ocular Surface Squamous Neoplasia in Pterygia: A Systematic Review and Meta-Analysis. British Journal of Ophthalmology. 2025 Oct. doi: 10.1136/bjo-2025-328299.
Habibalahi A, Allende A, Michael J, Anwer AG, Campbell J, Mahbub SB et al. Pterygium and Ocular Surface Squamous Neoplasia: Optical Biopsy Using A Novel Autofluorescence Multispectral Imaging Technique. Cancers. 2022 Mar; 14(6): 1591. doi: 10.3390/cancers14061591.
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