Introduction: High recurrence of a fibrotic disease, pterygium, following the surgical procedure is perceived as the primary challenge of its management. As the standard procedure, adjuvant therapy of using mitomycin C could dramatically reduce the recurrence of pterygium but could cause multiple serious complications. Our study aimed to investigate curcumin and fibrin glue as alternative candidates for adjuvant therapy in pterygium surgery. Methods: Human pterygium fibroblast (HPF) was isolated from the patient and cultured in-vitro. The HPF culture was then exposed with mitomycin C (0.4 mg/mL), curcumin (200 μmol/L), and fibrin glue, respectively, for 48 hours. The outcomes were determined by the proliferation of HPF and the expression of transforming growth factor-beta (TGF-β) which were obtained from 2,5-diphenyl-2H-tetrazolium bromide assay and immunofluorescence staining analysis with TGF-β antibody. Results: The experiment revealed that mitomycin C, curcumin, and fibrin glue could significantly inhibit the proliferation of HPF (p<0.05) suggesting their antifibrotic effect. Further analysis with immunofluorescence staining showed that mitomycin C, curcumin, and fibrin glue could significantly reduce the level of TGF-β as compared with control group (p<0.05). Conclusion: Mitomycin C was the most potent adjuvant agent to reduce the recurrence of pterygium, followed by curcumin and fibrin glue. Taken altogether, curcumin and fibrin glue have role as adjuvant therapy to prevent recurrence in pterygium surgery.

BACKGROUND: Pterygium is an ocular surface disease that often occurs in tropical countries with a high recurrence rate. Matrix metalloproteinase-3 (MMP-3) play a key role in the inflammatory process of pterygium. This study aims to investigate the ability of curcumin and fibrin glue (FG) in suppressing the expression of MMP-3, and whether can be expected as adjuvant therapy to reduce pterygium recurrence.METHODS: Human pterygium fibroblasts (HPF) obtained from primary cultured of pterygium were treated with no treatment, curcumin, mitomycin-C (MMC), and FG. MMP-3 expression was analyzed using immunocytochemistry and the intensity measurement was done using ImageJ software. Cell migration was measured by scratching and stratification of fibroblast culture after cell confluence, and assessed for 48 hours.RESULTS: The expression of MMP-3 were lower in the HPF treated with 100 mol/mL curcumin, 200 mol/mL, and FG (2205.84±86.1 pg/mL, 1002.51±25.22 pg/mL, 1131.55±17.71 pg/mL, respectively) in comparison with untreated HPF (4703.49±108.9 pg/mL). The expression of MMP-3 were significantly different between groups (p<0.001). Cell migration of HPF after scratching with curcumin intervention at 200 mol/mL decrease from 178.67±2.85 (24 hours) to 88.83±1.48 (48 hours). Meanwhile the migration in FG group also decrease from 180.4±2.56 (24 hours) to 72.45±1.25 (48 hours).CONCLUSION: Curcumin and FG able to reduce the expression of MMP-3 and inhibit the migration of HPF cells.KEYWORDS: curcumin, mitomycin C, fibrin glue, human pterygium fibroblast, MMP-3

Introduction : Age Related Macular Degeneration (AMD) stills the leading cause of blindness in developing countries for age 50 and above, increasing along higher life expectations.Anti- VEGF is the mainstay management for exudative AMD and able to reduce the central retinal thickness (CRT) and to increase the visual outcome. The aim of this study is to correlate between CRT and visual outcome in exudative AMD post intravitreal ranibizumab injection loading doses in Soetomo general academic hospital, Surabaya Methods : This was a retrospective, cross sectional study. Fourty two eyes who met inclusion criterias were received monthly loading doses of 0.5 mg Ranibizumab intravitreal injection for three consequtives months. Baseline visual acuity (BCVA) was measured with Snellen Chart converted to LogMAR, CRT was measured by SD-OCT. Parameters was measured before the first injection and after completed three months injections. Result : Fourty two eyes were composed by 59.5% male and 40.5% female with higher incidence in 61-70 years old (47.6%). Mean BCVA were 0.831 before and 0.624 after injection of serial Ranibizumab. Mean CRT were 346.9 and 254.2 µm before and after injection respectively. There was significant comparison between CRT and BCVA (p=0.00) & no correlation between CRT and BCVA before and after injection of Ranibizumab loading doses (p=0.418 & p=0.275) Conclusion : There were no correlation statistically between CRT and BCVA before and after injection of loading doses Ranibizumab intravitreal in exudative AMD. Further studies may be needed to prove the etiology of this tendencies.

Background: Recurrence remains a great challenge for pterygium management. Recurrence pterygium is also known to be more difficult to manage. Thus, this study focuses on recurrence prevention by exploring the potential of curcumin through its anti-angiogenesis properties.Methods: An experimental study was performed using cultured Human Pterygium Fibroblast (HPF). HPF was cultured to 90% confluency rate on cell culture and divided into three groups. Control group as a negative control, curcumin 100 µmol/L and curcumin 200 µmol/L were applied to each group of cell cultures. After 48 hours, VEGF expression was analyzed using immunofluorescence staining and fluorescein microscope, then the intensity was measured using ImageJ software.Results: Curcumin successfully decreases VEGF expression with a mean in control group 88.61 ±20.05 pixels; curcumin 100 µmol/L 52.64 ±2.74 pixels; curcumin 200 µmol/L 36.30 ±2.74 pixels on HPF. The Tukey HSD posthoc test found significant decrease between control group and each treatment group (p=0.000, p=0.000, and p=0.004; respectively) Conclusions:In conclusion, Curcumin has a potential effect on reducing VEGF expression in human pterygium fibroblast.

Pterygium is a wing-shaped growth from the conjunctiva and fibrovascular tissue onto the surface of the cornea. It has a high postoperative recurrence rate (which can be as high as 89% and its severity may vary according to the approach adopted and the preoperative conditions). To reduce the postoperative recurrence rate, several surgical techniques have been developed. The pathophysiology of pterygium development is diverse, one of the main factors is the proliferative process initiated by the TGF-mediator. One of the therapies developed to prevent pterygium recurrence is by targeting therapy on the proliferative pathway by adding pterygium surgery with adjuvant MMC therapy. MMC plays a role in inhibiting DNA synthesis, thereby reducing TGF-expression and ultimately inhibiting cell proliferation. Although it can reduce the recurrence rate quite well, MMC has numbers of complications. Therefore, an agent is needed to suppress pterygium proliferation which is relatively safer. Curcumin is a compound derived from the tuber of Curcuma longa L. which includes polyphenols. Curcumin modulates proliferation by stimulating the formation of TGIF which is a negative regulator of TGF-so that it can modulate proliferation.