The Mechanism Of Allergy Factors Promoting Pterygium In Juveniles

Purpose:To study the correlation between allergic conjunctivitis and pterygium disease.Methods:This study was a single-center study.Thirty-eight(40 eyes)juvenile pterygium patients who were examined the Xiamen Eye Center of Xiamen University from October 2014 to December 2019 were selected as the experimental group;40 middle-aged and elderly pterygium patients(40 eyes)were selected as the control group.All subjects were observed and evaluated for the following indicators:ocular surface disease index(OSDI),tear height(TH),tear film break up time(BUT),corneal fluorescein staining(FL),vision,intraocular pressure,staging and grading of pterygium under slit lamp,eye redness index score(degree of conjunctival hyperemia),detection of allergic conjunctivitis.In order to control the variables to focus on the correlation between allergic conjunctivitis and pterygium in juveniles,we divided each group into static and advanced phases for dependent comparison.Results:The OSDI value,tear height,tear film break up time,eye redness index score,and positive rate of allergic reactions in juvenile pterygium were significantly more apparent than those in middle-aged and elderly patients.These differences were more significant in patients in advanced stages.However,there were no significant differences of visual acuity and intraocular pressure and corneal fluorescence staining scores between the two groups.Conclusion:There are obvious symptoms of allergic conjunctival in juvenile patients with pterygium.The main manifestations include itching,conjunctival hyperemia,positive skin test,and positive blood test results.Among them,patients with advanced pterygium are severe and remarkable.In the middle-aged and elderly patient group,there were more obvious symptoms of dry eye,the dry eye complications in juvenile patients were lighter.The dry eye indicators were better and the meibomian glands morphology seemed more normal.Therefore,the incidence of pterygium in juveniles may be related to allergic conjunctivitis.Purpose:To detect the expression of immune response-related factors in pterygium of juvenile patients,and to explore the stimulation of allergic conjunctivitis in development of pterygium disease in juveniles.Methods:In this experiment,the pathological tissues of 40 adolescent pterygium patients,40 middle-aged and elderly pterygium patients,and 40 normal conjunctival tissues were collected for frozen-embedded sections,H&E staining,PAS staining,toluidine blue staining,immunofluorescence staining and immunohistochemical experiments.H&E staining was used to observe the gross tissue morphology and neovascularization of pterygium and normal conjunctival tissue.PAS staining was used to detect the difference in the distribution of goblet cells in pterygium and normal conjunctival tissue.Toluidine blue staining was used to detect the different expression of mast cells in normal and conjunctival tissues.The expression of α-SMA,MUC5-AC,TSLP,K14,Ki67,EGFR,and other interleukin family antibodies in pterygium and conjunctival tissue was detected by immunofluorescence technology.Results:H&E and α-SMA staining results combined with the eye red index showed that there were obvious positive staining areas in the pterygium of juvenile patients,and the staining of new blood vessels was obvious.PAS staining and MUC5-AC staining results showed that goblet cells were highly expressed in juvenile patients,and only weakly expressed in the tissues of middle-aged patients.Allergic indicators such as IL-33 and TSLP were not expressed in normal conjunctiva and middle-aged pterygium,but positive expression was detected in juvenile pterygium.Proliferation indicators including p63,K14,Ki67,EGFR expressed stronger in juvenile pterygium tissue than in middle-aged pterygium tissue and normal conjunctiva,and showed consistent distribution in head and body parts.Epithelial expression is stronger than matrix of pterygium.Toluidine blue staining results were significantly expressed in juvenile pterygium tissue,but not in middle-aged tissue and normal conjunctiva.K1,K7 and other cell phenotypic staining results showed little difference in juvenile and middle-aged pterygium tissue,but the expression level of epithelium was more abundant than in normal conjunctival tissue.Conclusion:Positive expressions of immune factors were detected in juvenile pterygium tissue,and the intensity was higher than that of elderly tissues and normal conjunctiva tissues,which may be caused by allergic conjunctivitis.Meanwhile,the immune process may stimulate the development of pterygium.