Comparison of surgical techniques for recurrent pterygium

Although conjunctival autograft (CAU) and amniotic membrane grafting (AMG) with mitomycin-C (MMC) are most effective for the treatment of primary pterygium, the optimal surgical treatment of recurrent pterygium is not well established. We thus aimed to examine recurrence rates after recurrent pterygium excision surgery performed with CAU or AMG with or without MMC.

We performed a retrospective review of adult patients who underwent recurrent pterygium excision surgery at Boston Medical Center between January 1999 and July 2019. Postoperative recurrence rates were compared between surgical treatment groups: CAU + MMC, CAU, AMG + MMC, and AMG. Postoperative and any intraoperative complications were recorded.

We identified 41 eyes of 38 patients having undergone recurrent pterygium excision surgery that met our criteria. The observed postoperative recurrence rates were 0% (0 of 8 eyes) with CAU + MMC, 17.7% (3 of 17 eyes) with CAU, 45.5% (5 of 11 eyes) with AMG + MMC, and 80.0% (4 of 5 eyes) with AMG. The postoperative recurrence rate was significantly lower with CAU than with AMG, both with (p = 0.045) and without (p = 0.021) adjuvant MMC. There were no statistically significant differences in repeat recurrence rates with or without MMC with CAU (p = 0.52) or with AMG (p = 0.31). There was 1 reported case of possible complication from MMC resulting in complete amniotic membrane melt.

Our study suggests that CAU results in less repeat recurrence than AMG in the treatment of recurrent pterygium. The use of intraoperative MMC may decrease the recurrence rate, but it is not statistically significant and may be associated with complications.