Extensive versus limited pterygium excision with conjunctival autograft: outcomes and recurrence rates

To compare the long-term outcomes and recurrence rate of extensive versus limited subconjunctival pterygium excision with conjunctival autograft.

This retrospective study included 135 consecutive patients (161 eyes) who had pterygium excision with conjunctival autograft at the cornea performed at the cornea service of the Toronto Western Hospital. Ninety-one had limited pterygium excision, and 70 had extensive pterygium excision with conjunctival sparing. Main outcome measures included the recurrence rate.

The recurrence rate in the limited excision group was 12.1% compared with only 4.3% in the extensive pterygium excision group (p = 0.14). The mean time to recurrence was shorter with limited excision compared to extensive excision (4.0 vs. 5.3 months, respectively, p = 0.16). Limited pterygium excision had a hazard ratio of recurrence of 3.2 compared with the extensive excision method. Recurrence-free survival analysis showed a significant advantage for the extensive excision group (p = 0.045, log-rank test). Cox proportional hazards regression found that younger age (p = 0.0003), larger area of corneal involvement (p = 0.004), worse preoperative visual acuity (p = 0.01), and limited pterygium excision (p = 0.04) significantly increased the risk for recurrence.

Both limited and extensive pterygium excision groups had low recurrence rates. The extensive subconjunctival pterygium excision group tended toward fewer recurrences, which occurred later.