Antabha Bandyopadhyay, Suchitra Kumari
Background: Pterygium is a common degenerative disorder of the ocular surface characterized by fibrovascular proliferation of conjunctival tissue onto the cornea. Progressive enlargement of the lesion alters corneal curvature, resulting in induced astigmatism, reduced visual acuity, chronic ocular irritation, and cosmetic concerns. Although several surgical techniques have been developed for pterygium excision, their comparative effect on postoperative corneal astigmatism remains a subject of ongoing research. Aim: To compare the effect of different pterygium surgery techniques on postoperative corneal astigmatism and visual outcomes. Methods: A prospective comparative study was conducted in the Department of Ophthalmology, Shaheed Nirmal Mahto Medical College and Hospital (SNMMCH), Dhanbad, over a period of 28 months. Eighty eyes with primary nasal pterygium were enrolled and equally allocated into four groups according to the surgical technique performed: Bare Sclera (BS), Conjunctival Autograft with Sutures (CAG-s), Conjunctival Autograft with Fibrin Glue (CAG-g), and Conjunctival Rotational Flap (CRF). Preoperative assessment included visual acuity, slit-lamp examination, autorefraction, and keratometry. Corneal astigmatism was calculated from keratometric readings. Patients were followed at one week, one month, and three months after surgery. Statistical analysis was performed using paired t-test, one-way ANOVA, and Spearman correlation analysis. Results: Among the 80 patients included, 46 (57.5%) were males and 34 (42.5%) were females, with a mean age of 37.42 ± 8.48 years. Corneal astigmatism decreased significantly following pterygium excision, with the overall mean astigmatism reducing from 3.17 ± 0.91 D preoperatively to 1.14 ± 0.51 D at three months (p<0.001). Uncorrected visual acuity improved significantly from 0.58 ± 0.31 LogMAR preoperatively to 0.31 ± 0.18 LogMAR at three months (p<0.0001). Greater preoperative astigmatism was associated with higher grades of pterygium. Although all four surgical techniques produced significant reductions in postoperative astigmatism, no statistically significant difference was observed among the techniques (ANOVA, p=0.057). Conclusion: Pterygium excision significantly reduces corneal astigmatism and improves visual acuity irrespective of the surgical technique employed. The magnitude of induced astigmatism is primarily related to the extent of corneal involvement rather than the method of surgical reconstruction. Keywords: Pterygium; Corneal astigmatism; Conjunctival autograft; Bare sclera; Fibrin glue; Conjunctival rotational flap.