Platelet-rich fibrin membrane versus conjunctival autograft in primary pterygium surgery: A comparative 12 months single center study

• Platelet-rich fibrin membrane (PRFm) grafting showed lower recurrence compared to conjunctival autograft (1.5% vs. 9.2%) in this pilot study; however, limited events (n=8) prevent definitive statistical conclusions. • PRFm reduced surgical time by 53% (20 minutes), providing substantial operational benefits including reduced patient discomfort and improved surgical efficiency. • Within-group improvements in patient-reported symptom scores (VAS and OSDI) were more pronounced with PRFm; however, between-group comparisons at individual timepoints showed no statistically significant differences. • Postoperative conjunctival inflammation was lower with PRFm during the early postoperative period (first 3 months); inflammation resolved similarly in both groups by 12 months. • These exploratory findings from a nonrandomized pilot study suggest PRFm may offer operational advantages; confirmation in a larger randomized controlled trial is warranted. To compare the safety and preliminary efficacy of platelet-rich fibrin membrane (PRFm) versus conjunctival autograft (CA) for primary pterygium surgery. Prospective, comparative, non-randomized pilot study. This pilot study enrolled 141 patients (76 Group A/CA; 65 Group B/PRFm) undergoing primary pterygium surgery between February 2024 and April 2025. Patients selected their preferred treatment approach. Primary outcome was pterygium recurrence at 12 months (Solomon grading scale). Secondary outcomes included conjunctival inflammation (Efron scale), ocular surface symptoms (Visual Analog Scale and Ocular Surface Disease Index), corneal epithelialization time, visual acuity, surgical time, and graft integration (AS-OCT imaging). Recurrence occurred in 7 eyes (9.2%; 95% CI 3.8–17.8%) in Group A and 1 eye (1.5%; 95% CI 0.0–8.2%) in Group B. Mean surgical time was substantially shorter with PRFm (18.2±5.2 minutes versus 38.5±7.1 minutes; 53% reduction; p<0.001). Conjunctival inflammation was consistently lower in Group B through 3 months (p<0.001 at 1 month), with resolution in both groups by 12 months. Within-group improvements in symptom scores were substantially greater with PRFm (VAS frequency 88.6% decrease versus 41.5%; OSDI 44.2% decrease versus 18.6%), with PRFm crossing from moderate to mild symptom category. However, between-group comparisons at individual postoperative timepoints demonstrated no statistically significant differences in symptom outcomes (all p>0.05). AS-OCT measurements were comparable between groups at all timepoints, with no significant associations between graft morphology and clinical outcomes. Both procedures demonstrated excellent safety profiles with no serious adverse events. This pilot study suggests PRFm may offer operational advantages and potentially favorable preliminary trends in recurrence and symptom improvement compared with CA for primary pterygium surgery. These exploratory findings warrant investigation in a larger randomized controlled trial with adequate power to determine whether observed trends represent clinically meaningful advantages.