Extensive recurrent pterygium following photorefractive keratectomy: a case report

To report an extensive recurrent pterygium following photorefractive keratectomy. A healthy 39-year-old male presented with an extensive recurrent pterygium three months after uneventful photorefractive keratectomy. The patient had undergone primary pterygium surgery two months earlier. On presentation, his best-corrected visual acuity was 20/60, and the recurrent pterygium extended across the visual axis. Surgical management included pterygium excision, application of mitomycin C, and free conjunctival autografting. At six-month’s postoperative follow-up, uncorrected visual acuity and best-corrected visual acuity improved to 20/32 and 20/25, respectively, with a manifest refraction of +3.25 – 3.5*90. A mild corneal sub-epithelial haziness was observed in the right eye, but no pterygium recurrence was noted. At 33 months postoperative visit, best-corrected visual acuity improved to 20/20 with manifest refraction of Plano – 1.5*110. There was no sign of pterygium recurrence. The excimer laser, operating within the ultraviolet spectrum, combined with the inflammatory cascade triggered by photorefractive keratectomy, may contribute to pterygium recurrence. In patients with pterygium who are candidates for keratorefractive surgery, selecting a surgical technique with the lowest recurrence rate and ensuring an adequate follow-up period—at least six months—to allow for refractive stabilization and confirm the absence of recurrence is crucial before proceeding with corneal refractive surgery.