Comparison of Recurrence Rate and Outcomes of Pterygium Surgery with Inferior Versus Superior Rotational Conjunctival Flap: A Randomized Clinical Trial.

PURPOSE: Limited knowledge exists about the recurrence and complications of rotational flaps harvested from the inferior bulbar conjunctiva in pterygium surgery. This study aimed to investigate the outcomes and recurrence rate of pterygium surgery using inferior rotational conjunctival flap (IRCF) compared with superior rotational conjunctival flap (SRCF) surgery. METHODS: This randomized clinical trial was performed on 82 candidates for pterygium surgery (primary pterygium with horizontal extension > 3 mm). The patients had been admitted to Amiralmomenin Hospital (Rasht, Iran) in 2023-2024 and were randomized to "group A" (IRCF surgery) and "group B" (SRCF surgery) using a single-blind method. They were visited on days 1, 3, 7, 30, 90, and 180 post-surgery, and their best corrected visual acuity (BCVA), clinical inflammation, complications, and recurrence were recorded and compared using SPSS version 26. RESULTS: Recurrence was observed in two patients in each group: in group A, one case in the third month and another in the sixth month post-surgery; and in group B, two cases in the third month post-surgery. Frequency of corneal epithelial defect healing, frequency of complications, inflammation severity, BCVA, and recurrence rate did not differ between the two groups at any follow-up visits (P > 0.05). There was no statistically significant difference between the two groups in terms of recurrence rates, categorized by pterygium size and age, at any time point (P > 0.05). CONCLUSION: Pterygium surgery with IRCF can be a safe and effective method for treating primary pterygium, especially when potential glaucoma filtration surgery is considered or when a proper superior bulbar conjunctiva is not available. Further multicenter prospective trials are needed to confirm the benefits of this technique.