Hypersensitivity Reaction in Inflamed Pterygium

1. Suharianti Soediro¹
2. Gantira Natadisastra¹
3. Imam Supardi²
4. Bethy S Hernowo²
5. Ani Melani Maskoen²

¹Cicendo Eye Hospital Bandung- Department of Ophthalmology Universitas Padjadjaran
²Hasan Sadikin General Hospital- Faculty of Medicine Universitas Padjadjaran

Purpose:
Pterygium is a fibrovascular tissue growth of the subepithelial conjunctiva that is shaped like a triangle, crossing the limbus to the cornea. The high recurrence rate of inflamed pterygiums postoperatively gave the interest for the researcher to study the immunopathology in the pathogenesis of pterygium The purpose of this study is to learn the etiopathogenesis of pterygium, based on the IL-4 cytokine levels from the tear fluid, as well as CD4 T lymphocyte from inflamed and non-inflamed pterygium tissues

Methods:
This is an observational, prospective, comparative study with a cross sectional design, done in a 7 month period from October 2009 to April 2010 in Cicendo Eye Hospital, Bandung, which included 58 patients with inflamed pterygium and 42 with non-inflamed pterygium selected through consecutive sampling from admission that met the criteria of the study. Examinations of the IL-4 cytokine levels from the tear fluid and CD4 T lymphocyte from the pterygium tissue were done. Statistical analysis was done with t-test, Mann-Whitney test, Shapiro Wilk test, and point biserial correlation.

Results:
The result showed a significantly higher level of IL-4 in inflamed pterygium, showing type I hypersensitivity reaction. Increased CD4 T lymphocyte level in inflamed pterygium also suggested a type IV hypersensitivity reaction. There was a correlation between IL-4 level and CD4 T lymphocyte in inflamed pterygium cases.

Conclusions:
There are type I and IV hypersensitivity reactions in inflamed pterygium and also a correlation between IL-4 level of the tear fluid and CD4 T lymphocyte in inflamed pterygium tissues.