Optimising the results of pterygium surgery: a review of current surgical approaches

Background: pterygium is a prevalent condition worldwide that can lead to impaired vision due to astigmatism, inflammation, irritation, or encroachment on the visual axis. Various surgical interventions are available for the primary excision and reconstruction of the ocular surface. Two standard surgical techniques are primary excision with conjunctival autograft transplantation (CAT) and primary excision with amniotic membrane transplantation (AMT), with or without adjunctive treatment with mitomycin C. This study evaluates these two techniques concerning their recurrence rates, effects on visual acuity, and influence on aesthetic appearance.<br/><br/>Methods: we used PubMed to identify studies comparing the outcomes of CAT and AMT for individuals undergoing pterygium surgery, including both primary and recurrent cases. The primary outcome measured was recurrence, and only studies with a minimum follow-up period of six months were included for 13 studies.<br/><br/>Results: atotal of 13 studies involving 1,272 eyes were analysed. AMT was performed on 549 eyes, while CAT was applied to 723 eyes. Among the eyes treated with AMT, 132 (24.0%) experienced a recurrence of pterygium compared to 69 eyes (9.5%) treated with CAT. Several studies showed improvements in post-operative visual acuity, corneal topography and cosmesis.<br/><br/>Summary: AMT exhibited a higher recurrence rate than CAT. However, the use of intraoperative adjuncts, such as mitomycin C, has further reduced the recurrence rate for patients undergoing either surgical procedure, as well as enhancing vision and cosmesis.