Assessment of post-operative changes after pterygium surgery with amniotic membrane transplantation using optical coherence tomography angiography (OCTA)

PurposeTo characterize the spatiotemporal patterns of vascular remodeling following pterygium excision with amniotic membrane transplantation (AMT) using optical coherence tomography angiography (OCTA).MethodsThis observational study evaluated 43 eyes undergoing AMT. Serial OCTA imaging was performed over a 12-week postoperative period to quantify vascular dynamics in superficial and deep conjunctival layers. Quantitative parameters, including vessel density (VD), vessel length density (VLD), and vessel diameter index (VDI), were analyzed using automated image processing techniques.ResultsEarly assessment at Week 1 showed minimal vascular in-growth. By Week 4, progressive remodeling was evident, primarily driven by deep-layer anastomoses between host tissue and the graft area. By Week 12, a structured vascular network emerged; however, superficial perfusion remained significantly reduced compared to baseline. While deep-layer VD demonstrated substantial recovery, VDI remained statistically stable. Notably, OCTA identified persistent flow voids and heterogeneous perfusion, suggesting irregular host-derived vascular integration beneath the graft.ConclusionPost-AMT healing is mediated predominantly by deep-layer episcleral vascular remodeling. OCTA serves as a sensitive, non-invasive tool for monitoring subclinical vascular integration, offering potential biomarkers for surgical success and early pterygium recurrence.