Oleh Ilham Syifaur Pembimbing Dr. Rahmad Syuhada, Sp. M

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OLEH

Ilham Syifaur
PEMBIMBING
Dr. Rahmad Syuhada, Sp. M
INTRODUCTION

A pterygium is a fibrovascular growth of


the conjunctiva, commonly encroaching onto
the cornea.
Although the pathogenesis of pterygium
formation remains unclear, one of the major
demographic characteristics of pterygium is its
strong link with geographical latitude, thought
to be related to variations in ultraviolet-B (UVB)
light exposure.
Vitamin D levels influence the
development of a wide range of eye
pathologies, such as myopia, age-related
macular degeneration, and diabetic
retinopathy.
Considering that vitamin D is
synthesized endogenously from exposure to
sunlight, it may serve as a biomarker of
cumulative UVB exposure
METHODS

This population-based, cross-sectional study


comprised 12,258 adults (aged ≥19 years)
participating in the fifth annual Korea National Health
and Nutrition Examination Survey from 2010 to 2012.
The enrolled subjects underwent interviews, clinical
examinations, and laboratory investigations. The
serum 25(OH)D levels were measured, and pterygium
was examined by using a slit lamp. We used three
adjusted logistic regression models and selected
covariates as potential confounders.
DATA COLLECTION

Demographic variables including age, sex, area of residence,


education, income, smoking, alcohol drinking, regular exercise,
and sun exposure were collected from the health interview survey.

1. Education was categorized into high school education of ≤12


years or higher education
2. Monthly household income was categorized into the lowest or
the three highest quartiles of income.
3. Smoking status was divided into current smokers and non -
smokers (including ex-smokers), and
4. Alcohol consumption status was divided into heavy drinkers
and moderate drinkers to non -drinkers.
5. Regular exercise was defined as walking for >30 min at once,
at least 5 times a week.
6. Sunlight exposure was categorized as an average of <2, 2 –5,
or>5 h of sunlight per day.
7. The serum 25(OH)D was measured
using a radioimmunoassay kit
(DiaSorin Inc., Stillwater, MN, USA)
with a gamma counter (1470
WJZARD; Perkin-Elmer, Finland).
8. Hypertension was defined as systolic
blood pressure≥ 140 mmHg,
diastolic blood pressure≥90 mmHg,
or taking medication for the
treatment of hypertension.
9. Diabetes mellitus was defined as
fasting blood glucose ≥126 mg/ dL,
being diagnosed as such by health
care professionals, or taking insulin
or antidiabetic medications.
10. In this study, general obesity was
defined as a body mass index (BMI)
≥25 kg/m2, and abdominal obesity
was defined as a WC ≥90 cm for
men and≥80 cm for women
11. Pterygium
12. Slit-lamp examinations were also
performed to check for the
presence of cataracts
SISTICAL ANALYSIS

 All statistical analyses were performed using SAS software


(version 9.3; SAS Institute, Inc., Cary, NC, USA)

 The odds ratios (ORs) and 95% confidence intervals (CIs)


were calculated using 3 dif ferent models. Model 1 was
adjusted for age and exercise; model 2 was adjusted for age,
exercise, BMI, smoking status, and alcohol consumption
status; and model 3 was further adjusted for diabetes
mellitus, metabolic syndrome, hypertension, and
psychological stress.
RESULT

In the current study, 17,476 individuals


for whom serum 25(OH)D levels were
obtained were selected.
Of these, 4170 subjects aged <19 years
and 1048 subjects with missing data were
excluded. Finally, 12,258 participants aged
≥19 years were included in the analysis
because this was the age group for which
serum analyses were performed. The overall
prevalence of pterygium was 7.09, and 53.1%
(weighted percentage) of these subjects were
women.
All participants were
Asian, and the iris color was
brown to dark brown. Among
subjects aged ≥19 years, the
prevalence of pterygium in at
least one eye was 7.08%.
Among the subjects with
pterygium, 71.2% showed no
recurrence, while 28.8%
showed recurrence >2 times.
Tabel 1 :
The mean age of subjects with and without pterygium was
44.3±0.3 years and 63.2±0.36 years, respectively (P<0.001).

The prevalence of current smokers, cataract, blepharoptosis,


diabetes, hypertension, and longer sun exposure was higher
among subjects with pterygium than among those without
pterygium (P<0.001).
Table 2 :
Shows the weighted percentages of individuals with pterygium
for various serum 25(OH)D levels, daily sun exposures, and
occupations.
- The percentage of subjects with daily sun exposure >5 h was
higher in the pterygium group compared to the no-pterygium
group
- (60.7%) in the group with <2 h of sun exposure and 13.4% in
the group with >5 h of sun exposure)
Table 3 :
Model 1 (age and regular exercise):
Subjects with a serum 25(OH)D level> 30 ng/mL,
25–30 ng/mL, and 15–20 ng/mL had an OR
(95% CI). respectively, compared to those with a
serum 25(OH)D level<15 ng/mL.
Model 2 (BMI, smoking status, and alcohol
consumption) :
Had an OR (95% CI), compared to those with a
serum 25(OH)D level<15 ng/ mL.

The table 3 is combine table 1 and table 2 the


assosiation presistent ever after and additional
adjusment for diabetes, hypertension,syndrom
metabolic and psyological stress
The risk of pterygium was higher in
subjects with a serum 25(OH)D level> 15
ng/mL and daily sun exposure >5 h.
DISCUSSION

Herein, we investigated the prevalence of pterygium


according to the serum 25(OH)D level and daily sun exposure.
The key finding of the current study was that pterygium
prevalence was significantly higher when the subjects were
exposed to >5 h of daily sun and their serum 25(OH)D level was
>15 ng/mL.
In the human eye, vitamin D -target cells throughout the
retina were first identified by the presence of vitamin D -
dependent calcium binding protein.
Vitamin D is able to reduce inflammatory
mediators, enhance barrier function, and
protect ocular health. Vitamin D
augments corneal epithelial barrier function
through upregulation of the tight junction
proteins occludin and ZO-1 .
Therefore, some investigators have
suggested that vitamin D has the potential to
reverse the harmful ef fects to the corneal
epithelial barrier during infection and can
protect against inflammatory conditions
The authors showed that UVB modulates
corneal epithelial cell expression of antioxidants
and proinflammatory mediators by distinct
mechanisms. Alterations in the expressions of
these mediators are likely to be important for
regulating inflammation and protecting the cornea
from UVB-induced oxidative stress.
In the present study, serum 25(OH)D and
sun exposure were also positively associated with
recurrence of pterygium
Our study suggested that individuals with higher serum
25(OH)D levels and who were exposed to more sunlight were
more likely to have flesh -type pterygium rather than the
atrophic type.
Serum 25(OH)D is the most commonly used measure of
vitamin D status, as it is more easily quantified in blood than
any other form of vitamin D
CONCLUSION

In conclusion, the present study provides


epidemiological evidence of an association
between serum 25(OH)D level and pterygium in
a representative Korean population. Our results
suggest that the serum 25(OH)D level is
positively correlated with the prevalence of
pterygium.
This might suggest that although serum
25(OH)D exerts an anti -inflammatory action, its
ef fect on the ocular surface is minimal and not
enough to prevent local UV insult on the
conjunctiva. Rather, our study results support
the strong association between pterygium and
sunlight exposure using objectively measured
serum 25(OH) levels

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