Primary Pterygium Excision Surgery: Analysis of Risk Factors and Clinical Outcomes.

Purpose To evaluate clinical outcomes of primary pterygium excision surgery and analyze risk factors for pterygium recurrence. Setting Eye Treatment Centre, Cornea and External Diseases Service, Whipps Cross Hospital, London, United Kingdom. Methods Retrospective case series of eyes undergoing primary pterygium excision between August 2017 and July 2022. Patients who underwent "pterygium excision" documented in the electronic patient record system were identified. Patients with recurrent pterygium and those lost-to-follow-up were excluded. The duration of follow-up, type of surgery performed (primary conjunctival closure, conjunctival autograft, and amniotic membrane transplantation), recurrences with respect to the type of surgery performed, and postoperative complications were collected and analyzed. Results In total, 83 eyes (from 79 patients) were included. The mean age of our patient cohort was 59.3 ± 5.9 years. The most common ethnic distribution was Black Caribbean (15.7%). Conjunctival autograft was performed in 76 eyes (91.6%), primary conjunctival closure was performed in five eyes (6%) and amniotic membrane transplantation was performed in two eyes (2.4%). The recurrence rate with conjunctival autograft was 1.3% with a median time to recurrence of 2.98 months. Recurrence was significantly more common in patients below the age of 40 years (p=0.03). Recurrence was not significantly associated with gender (p=0.23), ethnicity (p=0.17), or grade of surgeon (p=0.38).  Conclusion Our findings demonstrate the effectiveness of conjunctival autograft with fibrin glue fixation for the surgical management of primary pterygium. Recurrence was found to be significantly more common in patients under the age of 40 years old. However, recurrence was not associated with ethnicity, gender, or surgeon grade.

Comparison of postoperative topical interferon-α2b versus intraoperative mitomycin C for pterygium recurrence prevention: a randomized clinical trial.

PURPOSE: To evaluate the effect of postoperative interferon-alpha 2b (IFN-α2b) ophthalmic drops versus intraoperative mitomycin-c (MMC) on preventing pterygium recurrence. METHODS: This prospective randomized clinical trial was conducted on patients who were candidates for pterygium surgery. A total of 75 patients were included in the study from December 2021 to December 2022, of which 64 patients (one eye each) were examined and analyzed based on the inclusion criteria. Then the patients were randomly assigned to control groups, intra-operative MMC (32 patients) and the intervention group, IFN-α2b drops after the operation (32 patients). All patients underwent pterygium surgery using the rotational conjunctival flap method. RESULTS: In terms of pterygium grading, 8 (12.5%), 25 (39.06%), and 31 (48.44%) eyes were in grades 1, 2, and 3, respectively. The average size of the pterygium was 3.6 ± 0.7 mm. The grade and size of pterygium had the same distribution in the two groups. There was no statistically significant difference between the two groups in the level of post-operative clinical inflammation. The present study showed no significant difference in complications between the two groups (p = 0.999). The recurrence rate in the control group was 9.4% (3 eyes), and 0% (no recurrence) in the intervention group (p = 0.119). CONCLUSIONS: interferon-alpha 2b group did not show a statistically significant difference in preventing pterygium recurrence compared to the mitomycin C group. The post-surgery administration of IFN-α 2b drops can effectively prevent pterygium recurrence with a comparable and even more compelling effect than MMC during surgery.

Sliding limbus-conjunctival flaps for minimizing the pterygium recurrence: a prospective tertiary care institute study.

Objective: To describe the surgical technique and long-term outcomes of sliding limbus-conjunctival flaps to treat primary pterygium. Methods: Our single-center, single-surgeon-based, prospective study (part of the postgraduate thesis) included primary pterygium patients. We included the larger pterygium in bilateral cases for our research. All patients underwent pterygium excision and reconstruction by sliding limbus-conjunctival flaps technique to minimize the recurrence rates. Similar surgical steps and drugs were used for all the enrolled patients. Two ophthalmologists (SS and MK) evaluated all cases for blinding purposes. A minimum follow-up of 12 months was ensured in all cases. Results: Fifty eyes of 50 patients underwent the sliding limbus-conjunctival flaps surgery at a mean age of 50.40 ± 15.05 years. There were 27 (54%) males and 23 (46%) females with nasal pterygium (100%), having an average horizontal size of 2.96 mm. A "with the rule" astigmatism was seen in 44 (88%) eyes with a horizontal keratometry value of 42.00 ± 2.83, which increased significantly to 42.23 ± 2.02 (p>0.05) after surgery. The visual acuity was improved by 1 Snellen's line in 21 cases, 2 lines in 4 cases, and by 3 lines in 1 case. No change in visual acuity was seen in 24 cases. The early minor postoperative complications were self-resolving. At a mean follow-up of 14.5 months, the recurrence was found in 2 patients (4%), one in the 3rd and the other in the 9th month. Conclusion: The sliding limbus-conjunctival flaps technique is a simple, safe, and efficient procedure for primary pterygium cases. Pterygium surgery positively affects the visual acuity and keratometry values in most patients, making it a cosmetic and functional ophthalmic surgical procedure.

Tear film cytokines as prognostic indicators for predicting early recurrent pterygium.

Cytokine profiles in tears have become a noninvasive biomarker for various ocular surface diseases. Therefore, the preoperative profile of cytokines in tear samples of 89 primary pterygium patients were obtained from Zhongshan Ophthalmic Center during 2015-2017. Compared to the tear cytokines in primary groups, the concentrations of IL-8, MMP-1, MMP-9, bFGF and VEGF were generally higher in recurrent pterygium group. The five cytokines were used to build diagnostic models by multiple machine learning algorithms, which can accurately distinguish non-recurrent and recurrent samples of primary pterygium patients. Besides, these cytokines were significantly associated with Recurrent-free survival (RFS) time in pterygium patients and further applied to develop a prognostic model which can estimate the prognosis of pterygium after resection. Afterward, a novel nomogram combined risk score of cytokines related biomarker and clinical characteristics was constructed, which manifested ideal accuracies to predict the 1 and 2 years' probability of pterygium recurrent events. Thus, our finding provides a more simple and accurate prediction for early pterygium recurrence after resection. It also affords a useful tool for ophthalmologists to choose the optimal treatment strategies for pterygium patients.

Application of a Deep Learning System in Pterygium Grading and Further Prediction of Recurrence with Slit Lamp Photographs.

BACKGROUND: The aim of this study was to evaluate the efficacy of a deep learning system in pterygium grading and recurrence prediction. METHODS: This was a single center, retrospective study. Slit-lamp photographs, from patients with or without pterygium, were collected to develop an algorithm. Demographic data, including age, gender, laterality, grading, and pterygium area, recurrence, and surgical methods were recorded. Complex ocular surface diseases and pseudopterygium were excluded. Performance of the algorithm was evaluated by sensitivity, specificity, F1 score, accuracy, and area under the receiver operating characteristic curve. Confusion matrices and heatmaps were created to help explain the results. RESULTS: A total of 237 eyes were enrolled, of which 176 eyes had pterygium and 61 were non-pterygium eyes. The training set and testing set were comprised of 189 and 48 photographs, respectively. In pterygium grading, sensitivity, specificity, F1 score, and accuracy were 80% to 91.67%, 91.67% to 100%, 81.82% to 94.34%, and 86.67% to 91.67%, respectively. In the prediction model, our results showed sensitivity, specificity, positive predictive value, and negative predictive values were 66.67%, 81.82%, 33.33%, and 94.74%, respectively. CONCLUSIONS: Deep learning systems can be useful in pterygium grading based on slit lamp photographs. When clinical parameters involved in the prediction of pterygium recurrence were included, the algorithm showed higher specificity and negative predictive value in prediction.

The Effect of Topical 0.05% Cyclosporine in the Prevention of Recurrence Following Pterygium Surgery.

OBJECTIVES: To evaluate the effect of topical cyclosporine A (CsA) (Restasis, Abbvie, Lake Bluff, IL, USA) on recurrence rates and tear metrics after pterygium excision and limbal-conjunctival autografting (LCUA) technique in patients with primary pterygium. METHODS: A total of 60 eyes of 60 patients with primary pterygium who underwent pterygium excision and the LCUA technique were evaluated prospectively. Among them, 30 eyes of 30 patients were treated with topical CsA (Restasis) for 6 months postoperatively (Group 1). The remainder of the patients were assigned to Group 2. The follow-up period was 12 months for each group. The primary outcome measures were a comparison of Schirmer I test and fluorescein tear break-up time (FTBUT) results, the recurrence rate, and postoperative complications. RESULTS: There were no significant differences in age (mean age of Group 1 and 2 was 55.0±9.7 years and 56.3±8.9 years, respectively) or sex between groups (p>0.05). Farmers were the largest group of patients (40.0%). Recurrence of pterygium was observed in 5 (16.6%) eyes in Group 1 and 8 (26.6%) eyes in Group 2. The recurrence rate was not statistically significant between groups (p=0.35). The complication rate was significantly lower in Group 1 compared with that of Group 2 (p=0.02). The average increase in Schirmer I and FTBUT values was significantly higher in Group 1 than in Group 2 (p<0.05). CONCLUSION: The use of topical CsA did not demonstrate any significant improvement in the recurrence rate of pterygium following LCUA surgery.

Recurrent Pterygium: A Review.

PURPOSE: To summarize the recent evidence regarding different aspects of pterygium recurrence. METHODS: Human-based studies from PubMed, Scopus, and Google Scholar were identified using the following keywords: conjunctival disease, pterygium, recurrent pterygium, pterygium recurrence, pterygium management/surgery, conjunctival autograft (CAU), amniotic membrane graft/transplant, and adjuvant therapy (January 2009 to February 2021). We reviewed risk factors associated with the recurrence of pterygium, timing of recurrence, medical treatments to prevent from recurrence, and nonsurgical and surgical alternatives for management of recurrence. RESULTS: Dry eye disease, black race, and young age are considered definite risk factors for recurrence. However, fleshy appearance of the pterygium and preoperative size remain controversial. Surgical techniques such as excessive suturing, insufficient conjunctival graft size, thick conjunctival graft with remained Tenon tissue, and postoperative graft retraction are considered possible risk factors for recurrence. Using fibrin glue instead of sutures can further reduce recurrence rates. Although recurrence could occur even after many years, most recurrences happen in the first 3-6 months after surgery. Multiple kinds of adjuvant medications are used before, during, or after the operation including mitomycin C (MMC), 5-fluorouracil (5-FU), corticosteroids, and anti-vascular endothelial growth factors (anti-VEGFs). Multiple weekly subconjunctival 5-FU injections are shown to be safe and effective in halting the progression of recurrent pterygium. Although topical bevacizumab is found to inhibit the growth of impending recurrent pterygium, the effect is mostly temporary. CAU is superior to amniotic membrane transplantation in the treatment for recurrent pterygia. CONCLUSIONS: There is yet to be a panacea in treating recurrent pterygium. Currently, there is not a globally accepted recommendation for treating recurrent pterygium with anti-VEGFs or 5-FU as a nonsurgical treatment. We strongly recommend using MMC as an adjunct to surgery in recurrent cases, with consideration of its specific complications. CAU is the most effective surgical treatment for recurrent pterygium, and other new surgical therapies need further investigation.

Long-term analysis of an unconventional way of doing double-head pterygium excision.

AIM: The aim of the study is to describe an unconventional technique of vertically split conjunctival autograft (CAG) for primary double-head pterygium and its long-term outcome. MATERIALS AND METHODS: This was a retrospective, noncomparative, interventional case series of 95 eyes of 95 patients, who underwent vertical, split CAG surgery without maintaining limbus-limbus orientation for primary double-head pterygium from January 2013 to January 2017. All patients were reviewed for recurrence in their follow-up period. RESULTS: The mean follow-up was 14.12 ± 9.42 months. The baseline characteristics included 44 males and 51 females, with a mean age of 56.24 ± 10.03 years. The only significant complication was recurrence rate of 2.10% (2 eyes out of 95). The most common secondary outcome was graft edema (36.84%, 35 eyes out of 95), which resolved without any intervention. The other outcomes such as graft retraction (12.63%), Tenon's granuloma (1.05%), and subconjunctival hemorrhage (34.73%) were also recorded. CONCLUSION: Unconventional vertical split CAG without maintaining limbus-limbus orientation has convincing results in treating double-head pterygium with lower recurrence rate.

Dry-Eye Disease in Recurrent Pterygium.

PURPOSE: The aim of this paper was to investigate the degree of inflammation and dry-eye disease (DED) in recurrent pterygium. METHODS: Fifty-five patients with a history of pterygium excision were divided into 3 groups - Group 1: no recurrence after the first excision; Group 2: recurrence after the first excision; Group 3: no recurrence after the second excision. Dry-eye symptoms and tear production were elicited for each patient. RESULTS: A high prevalence of DED was observed in patients with primary and recurrent pterygium based on self-reported dry-eye symptoms (63.6%) and an abnormal Schirmer test result (78.1%). There was a statistically significant difference (p = 0.025) in the Schirmer test values between patients with (5.6 mm) and without (11.4 mm) recurrence after surgery for primary pterygium. Patients who were cured after a second excision had an improved Schirmer test value (9.5 mm), although this was not significant. CONCLUSION: Pterygium recurrence is associated with a greater severity of dry eye, possibly by perpetuating ocular surface inflammation in the postoperative period.

Concomitant use of conjunctival tissue graft from the pterygium itself without rotation in pterygium surgery: A full circle in conjunctival autografting.

Purpose: The aim of this study is to describe a modified technique of using conjunctival tissue from the pterygium itself without any rotation of graft for the primary pterygium in eyes with glaucoma filtering bleb, glaucoma suspects, and in primary double-head pterygium using fibrin glue. Methods: In this retrospective, noncomparative, interventional case series, 98 eyes of 98 patients with primary pterygium operated between July 2011 to July 2016 were included. They underwent this technique from the pterygium tissue itself. There was no rotation of this graft, and it was adhered to the bare scleral defect with fibrin glue. Histopathological analysis of pterygium tissue was done to look for morphology and thickness of this thin conjunctival tissue obtained from pterygium tissue itself. The primary outcome measure was recurrence rate. Other outcome measures studied was graft retraction and graft edema. Results: The mean age was 52 ± 10.04 years. Mean follow-up was 14 ± 8.24 months. The only significant complication was recurrence rate of 4.08% (4 eyes out of 98). The most come secondary outcome was graft edema, 52.04% (51 eyes out of 98) which resolved without any intervention. Other outcome such as graft retraction, 32.65% was also recorded. Conclusion: Conjunctival tissue from the pterygium tissue itself without actual rotation appears to be a successful technique with lower recurrence rate for treating primary pterygium in eyes with glaucoma filtering bleb, glaucoma suspects, and in primary double-head pterygium.

THE USAGE OF LOW-DOSE MITOMYCIN-C (MMC) IN THE TREATMENT OF PTERYGIUM / Шинэ санаа Шинэ нээлт

@#BACKGROUND. To observe the efficacy and the safety of low-dose mitomycin-C (MMC) in the treatment of pterygium. MATERIAL AND METHODS. In a prospective, randomized and controlled clinical trial, a total of 550 eyes of 400 patients diagnosed with pterygium were randomly divided into the four groups - group 1:130 eyes of 100 patients without MMC; group 2:140 eyes of 100 patients , with 0.2g\L MMC; group 3:150 eyes of 100 patients, with 0.3g\L MMC; group 4:130 eyes of 100 patients, with 0.4g\L MMC. They underwent the excision of primary pterygium barely the sclera. Visual acuity, intraocular pressure (IOP), extraocular movement, iridocyclitis, scarring, symptoms (tearing, photophobia, foreign body sensation) and signs (conjunctival hyperemia, ulcer of sclera and cornea, perforation of sclera) of subjects, were recorded on the day of enrollment and after the surgery, on 2 weeks, 2 months, 6 months and 1 year. RESULTS. In a group 3 and 4, the recurrence of pterygium after the excision were less than that in group 1 and group 2 (р<0.01) . In a 4 group, after the surgery, there were more probability of raising IOP, iridocyclitis, symptoms and signs than that in group 1,2, and 3. СONCLUSION. Low dose MMC is effective in the treatment of preventing the recurrence of primary pterygium. It’s efficacy rises along with its density. And mean time, the safety of the treatment of low-dose MMC declines.

Large pterygium surgery: When coverage of the scleral bed justifies graft rotation. / Cirugía del gran pterigión: cuando la cobertura del lecho justifica la rotación del injerto.

OBJECTIVE: To perform a 12 month follow-up study to assess the safety and effectiveness of resection and conjunctival autograft fixed with Tissucol® in selected cases of large pterygium. The orientation of the graft was adapted to the morphology of the scleral bed for a better coverage free of traction, with limbal position being lost. METHODS: A prospective, non-comparative study of 10 cases of grade II or superior pterygium (7 primary, 3 recurrent) with at least 8mm of limbal extension. A wide scleral bed was obtained after pterygium and Tenon resection, with larger grafts being required to cover the defects. A superior conjunctival autograft was harvested and fixed to bare sclera using Tissucol. The orientation was adapted to the morphology of the scleral bed and limbal position was lost. Patients were periodically assessed for recurrence and complications for a period of 12 months. RESULTS: Minor complications occurred in 4 eyes. In one case a buttonhole was formed during dissection of the graft. Two presented with small limbal dehiscence, but epithelialisation was completed in the first week. In a third case, it was necessary to increase topical corticosteroids for pyogenic granuloma on the donor site, with secondary increased intraocular pressure (IOP). There were no recurrences after 12 months follow-up. CONCLUSIONS: A conjunctival graft of appropriate size adapted to the morphology of the scleral bed to ensure good coverage free of tension, provides good surgical results in selected cases of pterygium, regardless of the conservation the limbal orientation, with no recurrences after one year follow-up.

Conjunctival autograft in pterygium treatment.

Pterygium is characterized by the thickening of the bulbar conjunctiva and the invasion of the cornea from the sclerocorneal limbus to the central portion of the cornea. Pterygium produces corneal deformation, which extends toward the central portion of the cornea. The visual disorders depend on the corneal extent. The treatment goal is the removal of the corneal and conjunctival portion of the pterygium and the coverage of the resulting conjunctival defect. The association of the pterygium surgical excision was assessed with conjunctival autograft. For this purpose, a retrospective study was performed on 68 patients and was extended over 7 years (2009-2015). Patients with recurrent pterygium were excluded. The time for corneal re-epithelization and for the pain and photophobia disappearance was followed. The incidence of recurrence was also observed. Pain levels were assessed by using a 10-point visual analog linear scale (VAS). The mean time for ocular pain and photophobia disappearance was of 48 hours. The mean pain score was 3.38 at 24 hours after surgery. Corneal re-epithelialization was achieved in 60 hours after surgery. Recurrence occurred in 6 patients. It was concluded that pterygium surgical excision with conjunctival autograft is effective in pterygium surgery.

Uso de Mitomicina C intraoperatoria en la cirugía de Pterigion para evitar la ocurrencia de recidiva / Use of intraoperative mitomycin-c in pterygium surgery to prevent the pterygium recurrence

Objetivo: Evaluar la ocurrencia de recidivas y otras complicaciones con el uso de Mitomicina C intraoperatoria en la cirugía de pterigio. Diseño del estudio y métodos: Se diseñó un estudio de retrospectivo, comparando la aplicación de Mitomicina C 0,1% intraoperatoria con la realización de injerto en la cirugía de pterigion en la clínica Medyser de Bucaramanga, Colombia. Se estudiaron un total de 305 ojos operados en este centro entre el primero de marzo de 2014 y el 29 de febrero de 2016, distribuidos en dos grupos, 126 ojos en el grupo de expuestos y 179 ojos en el grupo de no expuestos. Resultados: Se encontró que existe un factor protector del uso de Mitomicina C aplicada intraoperatoriamente para disminuir la incidencia de complicaciones como el dellen corneal, presencia de recidivas, leucoma residual, sobreinfección, hemorragia subconjuntival, haze corneal y rasgado por la sutura, con mayor riesgo de presentar granulomas y reabsorción del injerto. Conclusiones: De acuerdo a esto, la utilización de la Mitomicina C se presenta como una alternativa muy segura y eficaz en el manejo quirúrgico del pterigion, usada al 0,1% por 30 segundos, como se propone; sin embargo, se hace necesario diseñar un ensayo clínico comparativo con el gold standard actual como es la realización del injerto libre con células limbares.

Objective: To evaluate the pterygium recurrence and complications by the use of Mitomycin C during surgery. Study Design and Methods: We designed a retrospective study, comparing the application of Mitomycin C 0,1% intraoperative with the use of a graft in pterygium surgery at the Medyser Clinic in Bucaramanga Colombia, we studied 305 eyes operated at this center between the fi rst March 2014 and 29 February 2016 and were distributed into two groups: 126 eyes in the exposed group and 179 eyes in the non-exposed group. Results: We found there is a protective factor in the use of Mitomycin C applied intraoperatively to decrease the incidence of complications as the corneal dellen, pterygium recurrence, residual leucoma, infection added, conjunctival hemorrhage, haze corneal and graft rupture by suture, with greater risk of granulomas presence and graft resorption. Conclusions: Accordingly, the use of Mitomycin C appears as a very safe and effective alternative, using a 0,1% by 30 seconds, as e proposed, in the surgical management of pterygium; however, it is necessary to design a comparative clinical trial with the today's gold standard as it is the realization of free graft with limbal cells surgery.

Clinical analysis of risk factors contributing to recurrence of pterygium after excision and graft surgery.

AIM: To find the risk factors related to the reproliferation of the pterygial tissue after excision and graft surgery. METHODS: Charts of 130 eyes of 130 patients who had pterygial excision from March 2006 to April 2011 were reviewed. Preoperative pterygium morphology, surgical methods, and adjunctive treatments were statistically analyzed for their relationship with recurrence. RESULTS: During the follow-up period, recurrence was observed in 20 eyes (15.4%). None of the preoperative morphologic features were affected the rate of the recurrence. However, an age < 40y [P =0.085, odds ratio (OR) 3.609, 95% confidence interval (CI) 0.838-15.540] and amniotic membrane graft instead of conjunctival autograft (P =0.002, OR 9.093, 95% CI 2.316-35.698) were statistically significant risk factors for recurrence. Multivariate analysis revealed that intraoperative mitomycin C (MMC) (P=0.072, OR 0.298, 95% CI 0.080-1.115) decreased the rate of recurrence. CONCLUSION: Younger age is a risk factor for reproliferation of pterygial tissue after excision and amniotic membrane transplantation (AMT) are less effective in preventing recurrence of pterygium after excision based on the comparison between conjunctival autograft and AMT. Intraoperative MMC application and conjunctival autograft reduce recurrence.

Subconjunctival bevacizumab for primary pterygium excision; a randomized clinical trial.

PURPOSE: To evaluate the local safety of bevacizumab and its effect on recurrence of primary pterygium excision. METHODS: This randomized, placebo-controlled clinical trial was conducted on 44 eyes of 44 patients randomized to Group 1 (bevacizumab) and Group 2 (balanced salt solution). Group 1 underwent pterygium excision with a rotational conjunctival flap and received a total of 7.5 mg subconjunctival bevacizumab (5 mg/0.2 mL on the day of surgery and 2.5 mg/0.1 mL on the fourth day after surgery). Group 2 received balanced salt solution in the same manner. Recurrence, defined as any fibrovascular tissue crossing the limbus, and the number of patients with >1.5 mm fibrovascular overgrowth on the cornea were compared between the study groups. RESULTS: There was no statistically significant difference between the study groups in terms of demographics, pterygium size, daily sun exposure, preoperative visual acuity, keratomeric readings, corneal astigmatism, or IOP (P>0.05). Three and four patients in each group at the three- and six-month visits, respectively, had more than 1.5 mm fibrovascular tissue overgrowth on the cornea (P=1 and 0.62, respectively). At the three-month visit, 3 patients in Group 1 versus 7 patients in Group 2 (P=0.13), and at the six-month visit 4 patients in Group 1 versus 8 patients in Group 2 (P=0.17) had fibrovascular tissue crossing the limbus. Patients in Group 1 experienced a statistically significant rise in IOP at the one-week visit (P=0.007). CONCLUSION: Bevacizumab had no significant effect on the recurrence rate of pterygium. Although the frequency of fibrovascular tissue crossing the limbus in the bevacizumab group was half that of the BSS group, the difference failed to reach a statistically significant level.

Young patient's age determines pterygium recurrence after surgery.

BACKGROUND: It is not clear whether demographic or pterygium characteristics or limbal stem cell deficiency determine pterygium recurrence after surgery. PURPOSE: To determine whether the demographic, pterygium characteristics, or limbal stem cell deficiency determine pterygium recurrence after excision. METHODS: Of 190 patients operated and followed-up for 6 months, 101 and 89 underwent free conjunctival autotransplant (CAT) or limbal conjunctival autotransplant (LCAT) respectively. The age, gender, occupation, grade of pterygium extent and degree of fleshiness, and laterality were compared between recurrent and no recurrent pterygia. Multivariate analysis was performed to determine the predictors of pterygium recurrence. Recurrence rates after surgery were compared between CAT and LCAT. RESULTS: The age range of the 190 patients was 22-65 years, mean ±SD 46.4 ±10.8 years. Pterygium recurred in 52 (27.4%). Thirty-nine (75%) of 52 patients with pterygia that recurred were aged <50 years (young) vs. 72 (52%) of 138 young patients with no recurrence; odds ratio (OR) = 1.54; 95% confidence interval (95% CI) = 0.70-3.36; p = 0.28. Thirty-one (60%) of 52 participants with post-surgical recurrent pterygia had large pre-operative pterygium (grade ≥3) vs. 130 (94%) of 138 patients with large pterygia that did not recur; OR = 0.11; 95% CI = 0.04-0.28; p <0.001. Of 101 patients undergoing CAT, 29 (28.7%) experienced recurrence vs. 23 (25.8%) of 89 undergoing LCAT; p = 0.66. CONCLUSIONS: Young age seems to be associated with pterygium recurrence after excision followed by conjunctival graft. Large pterygia were protective.