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Matthew Hochuen Ip, Jeanie J Y Chui, Lien Tat, Minas T Coroneo; The clinical significance of Fuchs' flecks in pterygia and pinguecula: are Fuchs' flecks an early indicator of ultraviolet light damage. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1624.
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© ARVO (1962-2015); The Authors (2016-present)
Fuchs' flecks (FF) have been previously identified at the leading edge of pterygia, and may represent stem-like cells that give rise to this condition. However, the frequency of occurrence of FF and their clinical significance remains undefined. We hypothesize that FF are precursor lesions that can give rise to ultraviolet light-related disorders such as pinguecula and pterygia. This study aims to evaluate the presence and clinical significance of FF in macroscopically normal eyes, pinguecula and pterygium-affected eyes.
A single center, retrospective observational case series was performed to evaluate the clinical significance of FF in ocular surface disorders such as pterygium and pinguecula by in vivo confocal microscopy (IVCM). 40 eyes from 20 patients with clinical diagnoses of pinguecula and/or pterygium in at least one eye were examined with IVCM (Rostock Cornea Module; Heidelberg Engineering Heidelberg, Germany). The main outcome measure was the presence of FF in patients with pinguecula and/or pterygium. Macroscopically normal paired eyes were also examined with IVCM to determine FF presence. Descriptive statistics were used to determine the percentage and frequency of FF in different limbal regions.
FF were present in 30 of 37 (81.1%) macroscopically normal nasal or temporal limbal regions, 12 of 12 (100%) pinguecula, 13 of 15 (86.7%) primary pterygia, and 8 of 8 (100%) of recurrent pterygia. No FF could be identified at the superior or inferior limbal regions.
High rates of FF were identified at the advancing head of pinguecula, primary pterygium, recurrent pterygium and in the macroscopically normal nasal and temporal limbal regions of the second eye in patients with unilateral disease. This suggests that FF may represent precursor lesions to ultraviolet-associated ocular surface pathology. The use of IVCM to identify FF may consequently permit clinicians to earlier diagnose and predict recurrence of pterygium and onset of pinguecula.
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