Recurrence-free time after pterygium surgery with sutureless conjunctival-limbal vs. conjunctival graft: is there still a role for conjunctival graft alone?

Purpose: To compare the risk of recurrence and disease-free time after conjunctival-limbal autograft (CLAG) or conjunctival autograft (CAG) with sutureless (fibrin glue) fixation for pterygium excision. Methods: This is a retrospective cohort study. We reviewed the charts of 312 patients who underwent CLAG and CAG sutureless techniques between 2010 and 2019. Follow-up visits were scheduled on day 1, at weeks 1 and 4, and at 3, 6, 9, and 12 months post-surgery, with subsequent visits every two years thereafter. The primary outcomes were the overall recurrence rate and average time to recurrence. The secondary outcomes were the rates of postoperative complications and the operation duration. Multivariate logistic regression was performed to verify the potential independent predictors of the study outcomes. Results: 265 patients were included, with a mean follow-up time of 31.5 months (maximum 8 years). The pterygium recurrence rate was significantly lower in the CLAG group at 12 months (3.9 vs. 17.4%, p < 0.001) and at the end of the follow-up (4.6 vs. 18.2%, p < 0.001). Patients with CLAG also had a longer time to recurrence (8.8 vs. 4.8 months, p = 0.012). The complications rate was lower for CLAG (0.8 vs. 10.9%, p < 0.001), while no clinically relevant differences were found in the surgery duration (23.4 min for CLAG vs. 25.2 min for CAG). Multivariate analysis confirmed these bivariate results. Conclusions: Compared with CAG, CLAG reduced the risk and time to pterygium recurrence. Owing to the comparable surgical time and better safety profile, the CLAG technique can be considered a clinically and potentially cost-effective approach for pterygium management.