Whether Limbal Graft is Necessary for Treating Recurrent Pterygia with Intraoperative Mitomycin C: A Prospective Randomized Controlled Trial on Limbal-Conjunctival versus Conjunctival Autograft

Objectives: To investigate whether the supplementation of corneal limbus in conjunctival grafting is necessary for treating recurrent pterygium or not when combined with intraoperative mitomycin C application. Methods A prospective randomized controlled trial of one hundred and thirty-two participants with recurrent pterygium undergoing limbal conjunctival autograft (LCAG) comparing conjunctival autograft (CAG) after pterygia removal and intraoperative application of 0.02% mitomycin C (MMC) for 5 minutes (n=66 eyes in each group). The patients were then followed up for 12 months. The main outcome was grade 4 recurrence rate of pterygium and postoperative complications. Results A 12-month follow-up was conducted on 126 patients, including 63 eyes in the LCAG group and 63 eyes in the CAG group. After surgery, grade 4 recurrence of pterygium was observed in 6 eyes in the LCAG (9.52%) group and 3 eyes in the CAG (4.76%) group ( χ ² =1.077; P =0.299). There was no significant correlation between the recurrence and surgical methods, patient age or gender, number of previous excisions, size of pterygia or autograft, or degree of pterygial vascularization. Furthermore, localized pannus formation at the donor site of limbal graft was observed in 19 eyes (30.16%) in the LCAG group. No signs of scleral or corneal melting, or limbal stem cell deficiency were noted during follow-up in any of the eyes. Conclusions An additional supplement of corneal limbus is not necessary in conjunctival grafting for treating recurrent pterygia. Trial registration number NCT04463901.