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The Evolving Story of Pterygium

Young, Alvin L., FRCOphth, FHKAM*,†; Cao, Di, PhD†,‡; Chu, Wai Kit, DPhil; Ng, Tsz Kin, PhD†,§; Yip, Yolanda W.Y., MSc; Jhanji, Vishal, MD†,‖; Pang, Chi Pui, DPhil

doi: 10.1097/ICO.0000000000001744

Abstract: Pterygium is a fibrovascular subepithelial growth of degenerative tissue over the limbus. It is a common condition worldwide that is especially prevalent in tropical countries within the “pterygium belt.” Its exact etiology remains to be elucidated; however, it is strongly associated with exposure to ultraviolet light. The high expression levels of tumor protein p53 (TP53) observed in laboratory studies of pterygium seem to contradict the fast-growing nature of its clinical behavior, and TP53 mutations have been suggested. We demonstrated that mouse double minute 2 (MDM2), a TP53-binding protein, contributes to the inhibition of TP53 activity in human pterygium. Thus, disruption of the MDM2-TP53 interaction should attenuate human pterygium cell growth. For primary pterygium, treatment is relatively straightforward and involves surgical excision. To minimize the risk of recurrence, many adjunctive therapies are adopted, including antimetabolites, such as mitomycin C and 5-fluorouracil, amniotic membrane, different variations on conjunctival and/or limbal conjunctival grafts, and other medications such as anti-vascular endothelial growth factor. In the future, MDM2 antagonists may help further lower the recurrence rates after the treatment of pterygium.

*Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China;

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China;

Department of Ophthalmology, Beijing Children's Hospital, Beijing, China;

§Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA; and

Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, China.

Correspondence: Alvin L. Young, FRCOphth, FHKAM, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received June 27, 2018

Accepted July 16, 2018

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