Beruflich Dokumente
Kultur Dokumente
Occurrence of human
papillomavirus in pterygia
Marta Piecyk-Sidor,1 Magorzata Polz-Dacewicz,2
1
_
Zbigniew Zagorski1 and Tomasz Zarnowski
1
ABSTRACT.
Purpose: The aim of the study was to assess the occurrence of human papillomavirus (HPV) DNA in pterygium.
Methods: The study involved 89 patients undergoing surgical procedures at the
Department of Ophthalmology, Medical University of Lublin, Poland. Group
1 included 58 patients with clinically diagnosed pterygium. Group 2 consisted
of 31 individuals with normal conjunctiva. The material was collected during
elective surgical procedures. The presence of HPV genome was determined
using polymerase chain reaction (PCR). Once the presence of HPV DNA was
conrmed, 28 HPV genotypes were determined using reverse hybridization.
Results: The determinations conrmed the presence of HPV DNA in pterygium. In the material collected from 58 cases of pterygium (group 1), HPV
DNA was identied in 16 patients (27.6%). In the material from 31 diagnostic
specimens of normal conjunctiva (group 2), the presence of HPV was demonstrated in three cases (9.7%). A statistically signicant difference was found
in the presence of HPV DNA between the patients from groups 1 and 2
(p = 0.041). HPV type 16 was most common and was demonstrated in 56%
of HPV-positive cases of pterygium. HPV 16 and HPV 6 co-infections were
found in 19% of cases, while HPV 18 and HPV 6 co-infections were observed
in 13%. In group 2, all three patients with HPV showed HPV 18.
Conclusion: It seems that HPV is not necessary to induce pterygium; however,
it might play a synergistic role in the multi-stage process of its development.
Key words: human papillomavirus occurrence PCR pterygium
doi: 10.1111/j.1755-3768.2008.01372.x
Introduction
Pterygium is a brovascular lesion of
the eye surface that tends to increase in
size and recur after surgical removal.
The Bowman membrane and supercial layers of the cornea beneath the
lesion are damaged. Visual acuity is
likely to decrease in advanced stages
890
Table 1. Comparison of the examined parameters in the pterygium patients (group 1) and in
pterygium-free patients (group 2).
Parameter
Sex
Female
Male
Age (years)
Mean
Age groups (years)
< 40
4049
5059
6069
> 70
Median test Median = 56.0
6
>
Place of residence
Town with > 30 000 inhabitants
Town with < 30 000 inhabitants
Countryside
Number of cases
Group 1
Group 2
20
38
3483
60.1 13.1
11
20
2481
55.3 15.4
v2 = 0.01; p = 0.908
1
17
13
8
19
3
9
8
2
9
v2 = 5.64; p = 0.227
25
33
20
11
v2 = 3.70; p = 0.054
10
14
34
58
8
11
12
31
v2 = 4.78; p = 0.091
Results
The determinations conrmed the
presence of HPV DNA in pterygium.
In the material collected from 58 clinically conrmed cases of pterygium
(group 1), HPV DNA was detected in
16 patients (27.6%). In the material
from 31 diagnostic specimens of the
clinically unchanged conjunctiva (group
2), the presence of HPV was
demonstrated in three cases (9.7%)
(Fig. 1). Analysis of the results
showed statistically signicant differences between the incidence of HPV
DNA in both groups examined (v2
Pearson: 3.859, p = 0.049; Fishers
exact test: p = 0.041).
Amongst seven cases of recurrent
pterygium, HPV 16 was detected in
two cases.
The group of 58 patients with
pterygium
included
20
women
(34.48%) and 38 men (65.52%). The
majority of patients with detected
HPV DNA were male 81.25%
(13 16); female patients constituted
18.75% (3 16). The group with negative results contained 25 (59.52%)
male and 17 (40.48%) female patients
(Table 4) There were no statistically
signicant differences found between
the presence of HPV DNA and sex
(p = 0.12).
Statistically signicant differences in
the presence of HPV DNA were
found between patients living in the
country and those from big towns.
(Chi2 = 4.85,
p = 0.028,
exact
Fischer test p = 0.026). In the
remaining cases, there were signicant
differences between the presence of
HPV DNA and the place of residence
(p = 0.089) (Table 5).
The majority of patients with pterygium and positive as well as negative
HPV DNA results were farmers (56.25%
and 45.24%). White-collar workers constituted the smallest group - 6.25% in
HPV positive group and 11.9% in HPV
negative group (Table 5).
The occurrence of HPV DNA versus to the place of work and versus
UV radiation exposure in patients
undergoing surgery due to pterygium
is presented in table 5.
There were no statistically signicant
differences found between the presence
of HPV DNA and the selected parameters such as age, type and place of
work, length of exposure to UV radiation or rst symptoms of pterygium.
891
100%
80%
60%
HPV ()
HPV (+)
40%
20%
27.60%
9.70%
0%
Patients without
pterygium
Fig. 1. Incidence of human papillomavirus (HPV) DNA in the material from patients with
pterygium (group 1) and without pterygium (group 2). (v2 Pearson: 3.859, p = 0.049; Fishers
exact test: p = 0.041).
Discussion
In our study, the presence of HPV
DNA in pterygium was conrmed in
6%
6%
13%
56%
19%
Fig. 2. Human papillomavirus (HPV) genotypes identied in patients with pterygium.
892
Stage III
HPV
HPV
HPV
HPV
HPV
3
2
1
1
1
18.75
12.50
6.25
6.25
6.25
6
1
1
0
0
37.50
6.25
6.25
0.00
0.00
50.00
50.00
16
6 and 16
6 and 18
16 and 31
11, 16, 18, 52, 53, 59
Total
HPV (+)
lesions, n (%)
100
36
10
32
17
24
65
10
50
3
4
0
5
4
17
5
0
5
12
0
HPV type
Study
HPV 6
(50%)
(12.5%)
(100%)
(21%)
(50%)
(24%)
HPV 6, 11, 16
HPV 18
DNA
HPV ())
Total
Sex
Females
Males
3
13
18.75
81.25
17
25
40.48
59.52
20
38
34.48
65.52
893
Table 5. Occurrence of human papillomavirus (HPV) DNA in patients with pterygium according to the type of work, place of work, place of residence and UV exposure.
Examined groups
Type of work
Farmer
white-collar worker
manual worker
Place of work
indoors
outdoors
Place of residence
Town > 30 0001
Town < 30 0002
Country3
Length of exposure to
<6 h
48 h
>8 h
DNA HPV(+)
DNA HPV())
n = 16
n = 42
Total
n = 58
9
1
6
56.25
6.25
37.50
19
5
18
45.24
11.90
42.86
28
6
24
p = 0.527
2
14
12.50
87.50
16
26
38.10
61.90
18
40
p = 0.059
0
0
10
4
25.0
10
12
75.0
22
UV radiation (h day)
2
12.50
12
4
25.00
8
10
62.50
22
23.81
23.81
52.38
10
14
34
28.57
19.00
52.40
14
12
32
p = 0.437
894
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