How to minimize pterygium recurrence rates: clinical perspectives

Figures & data

Figure 1 Postoperative results of a rotational flap, transposed from the inferior conjunctiva, with its vascular pedicle.

Table 1 Summary of main characteristics of different surgical techniques for pterygium excision

Technique	Advantages	Drawbacks
Bare sclera technique	• Easy to perform • Short surgical time	• High recurrence rates • Possible discomfort and pain (related to pterygium extension)
Conjunctival autograft	• Low recurrence rates • Easy to perform (in comparison with transpositional flap) • Good cosmetic results	• Long surgical time (especially in suture-assisted fixation) • Possible discomfort and pain (especially in suture-assisted fixation) • Cannot be applied in patients with insufficient conjunctiva • Risk of graft loss/displacement (sutureless fixation) • Possible conjunctival cicatrization • Difficulty in covering of large defects
Amniotic membrane	• Easier to perform (in comparison with conjunctival autografting) • Useful to cover large defects • Conjunctival sparing • Short surgical time • Can be applied in patients with insufficient conjunctiva	• Higher recurrence rates (in comparison with conjunctival autografting) • Risk of graft loss/displacement (sutureless fixation) • Possible discomfort and pain (suture-assisted fixation)
Conjunctival transpositional flap	• Low recurrence rates • Low risk of graft loss or necrosis • Better graft healing due to vascular pedicle • Short surgical time • Better postoperative cosmetic results (in comparison with conjunctival autografting) • Can be applied in patients with insufficient conjunctiva	• Challenging technique (in comparison with conjunctival autografting) • Difficulty in covering of large defects • Possible discomfort and pain (suture-assisted fixation)

Table 2 Summary of characteristics of different adjuvant treatments in pterygium surgery

Adjuvant treatment	Advantages	Drawbacks
Topical mitomycin C	• Significant recurrence rate reduction	• Low tolerability • Risk of severe toxicity (eg, corneoscleral necrosis) • Cannot be applied in case of thin sclera or preexisting corneal disease
Radiation	• Significant recurrence rate reduction	• No unified fractioning schemes • Corneoscleral toxicity • Possible late-onset toxicity (eg, infections and scleral ulceration)
Subconjunctival anti-VEGF	• Significant recurrence rate reduction • Good tolerability • Possible repeated injections	• High costs • Transient effect • No unified injection timing
Topical 5-fluorouracil	• Minor toxicity in pterygium surgery • Useful in recurrent pterygium	• Controversial efficacy • Limited evidence for pterygium surgery • No significant recurrence reduction when compared with simple surgery with conjunctival graft • Cannot be applied in case of thin sclera or preexisting corneal disease
Topical cyclosporine A	• Mechanism of action on multiple pathological processes • Good tolerability	• High costs • Limited evidence for pterygium surgery • Cannot be applied in case of thin sclera

Abbreviation: VEGF, vascular endothelial growth factor.