Recurrence rate, time to recurrence, and associated factors after primary pterygium excision with conjunctival-limbal autograft: a prospective cohort study

BACKGROUND: Pterygium recurrence remains a major postoperative challenge in equatorial regions with high ultraviolet (UV) exposure. Although several clinical and inflammatory factors have been proposed as predictors, evidence remains inconsistent. This study aimed to estimate the recurrence rate after primary pterygium excision with conjunctival-limbal autograft and to explore potential demographic, clinical, surgical, and systemic inflammatory factors associated with recurrence in a Colombian cohort. METHODS: This prospective cohort study included patients ≥ 18 years undergoing primary pterygium excision with conjunctival-limbal autograft at a high-complexity ophthalmology center in Bogotá, Colombia, between January and August 2024. Patients were followed until recurrence or last ophthalmologic follow-up, up to 10 months postoperatively. Recurrence rate was calculated and exploratory bivariate analyses were performed. Kaplan-Meier survival curves were generated. RESULTS: Ninety-one patients completed follow-up. The mean age was 50.9 years ± 13.0 years, and 59.3% (n = 54) were female. The recurrence rate was 13.2%, with a median follow-up of 197 days. Younger age was significantly associated with recurrence in bivariate analysis (mean difference - 11.2 years, p = 0.005). No statistically significant detectable associations were observed between recurrence and sex, laterality, pterygium grade, surgeon experience, or systemic inflammatory indices (NLR, PLR, SII, LMR, CRP, and ESR) (all p > 0.05). CONCLUSIONS: In this prospective cohort from a high-UV equatorial setting, the recurrence rate after primary pterygium excision was 13.2%. Younger age was associated with recurrence in exploratory analyses. The absence of statistically significant associations for systemic inflammatory markers and other variables should be interpreted cautiously, as the study may be underpowered to detect moderate effect sizes. These findings should be interpreted as hypothesis-generating and require confirmation in larger, adequately powered studies.