Flow cytometry measurements of DNA content in primary and recurrent pterygia

To evaluate DNA content and cellular proliferation rates in primary and recurrent pterygia.

Matched pterygium and superior conjunctiva tissue were obtained in 36 eyes of 36 patients undergoing pterygium excision with conjunctival autografting (24 primary pterygia, 12 recurrent pterygia). Epithelial and fibrovascular layers were separated for analysis. Matched superior conjunctiva obtained at the time of surgery were used as controls. Samples were prepared according to Thompson's method, and flow cytometry was performed with a Becton-Dickinson FACScan. Analysis of histograms and calculations of cell percentages in cell cycle phases were carried out using CellFit software (version 2.0). Mean proliferation indices (MPIs) were compared using the Wilcoxon matched-pair signed-rank test.

The MPI of pterygium fibrovascular tissue (13.4) was significantly higher than the MPI of pterygium epithelium (3.1; P = 0.0001). The MPI of pterygium fibrovascular tissue was also significantly higher than that of superior conjunctival fibrovascular tissue (6.0; P = 0.0001). There was no difference in MPI values between pterygium epithelium and superior conjunctival epithelium (3.55; P = 0.12). The MPI of fibrovascular tissue from recurrent pterygium (73.75) was significantly higher than the MPI of fibrovascular tissue from primary pterygium (7.3; P = 0.003).

The finding of high levels of cellular proliferation in the subepithelial fibrovascular layer of pterygium confirms that pterygium is a disorder of excessive cellular proliferation and that the fibrovascular layer is the site of cellular proliferation. Markedly raised levels of cellular proliferation in recurrent pterygium tissue suggest a clinical correlation between fibrovascular tissue upregulation and pterygium recurrence after surgery.