Evaluation of Ocular Surface Inflammation and Corneal Microstructural Changes in Pterygium Using in Vivo Confocal Microscopy: A Comparative Study of Surgical Techniques.

PURPOSE: To evaluate ocular surface, corneal sensitivity, subbasal nerve morphology, and dendritic cells (DCs) density in eyes with pterygium using in vivo confocal microscopy (IVCM), and to compare postoperative outcomes between amniotic membrane transplantation (AMT) and conjunctival autografting (CAG). METHODS: This prospective study included 41 patients with unilateral primary pterygium. Baseline and first-month postoperative findings were evaluated. Eyes with pterygium were compared with fellow eyes regarding dry eye parameters, corneal sensitivity and IVCM findings. Postoperative changes in ocular surface parameters, subbasal nerves, and DCs were evaluated following AMT or CAG. RESULTS: Preoperatively, eyes with pterygium had significantly lower tear film break-up time than fellow eyes (p = .036), whereas no significant differences were observed in IVCM parameters. At one month postoperatively, ocular surface disease index scores improved (p < .001), while corneal sensitivity decreased (p = .037). DCs and subbasal nerve tortuosity also decreased significantly (p = .041 and p = .016, respectively). Changes from baseline in ocular surface and IVCM parameters did not differ significantly between the AMT and CAG groups (all p > .05). CONCLUSIONS: Pterygium is associated with ocular surface inflammation and corneal microstructural alterations detectable by IVCM. Surgical treatment improves the health of the ocular surface, and both methods showed favorable anti-inflammatory results in a short follow-up period of one month; however, it would be more beneficial to evaluate this in conjunction with long-term outcomes. IVCM may serve as a valuable tool for assessing postoperative inflammatory changes in pterygium patients.