Prospective evaluation of vascular remodeling after pedicle versus free conjunctival grafts in pterygium surgery using anterior segment OCT angiography

This prospective observational study compared vascular remodeling after pedicle conjunctival flap (PCF) and free conjunctival graft (FCG) surgery with adjunctive mitomycin C (MMC) using anterior segment optical coherence tomography angiography (AS-OCTA). Sixteen eyes underwent pterygium excision and 0.02% MMC application followed by PCF ( n = 8) or FCG ( n = 8). Conjunctival and intrascleral vascular densities were quantified relative to preoperative values, and marginal corneal vascular arcade (MCA) formation was evaluated. In the PCF group, graft blood flow was observed from postoperative day (POD) 3, with vascular reconstruction and MCA reformation by POD 21. In the FCG group, scleral vascular ingrowth was observed by POD 21, whereas slight conjunctival ingrowth began by POD 14 and became more apparent by POD 90. Linear mixed-effects models showed consistently higher conjunctival vascular density after PCF, with a significant group-by-time interaction. Intrascleral vascular density was higher after PCF at most postoperative time points, although temporal profiles were broadly similar. Further studies are needed to determine whether these vascular differences translate into clinical benefits.