Pterygium Surgery Research Articles

Comparison of Samfilcon A and Balafilcon A Bandage Contact Lenses in Reducing Postoperative Symptoms After Pterygium Surgery

Comparison of Samfilcon A and Balafilcon A Bandage Contact Lenses in Reducing Postoperative Symptoms After Pterygium Surgery

Suture Less and Glue-Free Inferior Limbal Conjunctival Autograft Transplantation in Primary Pterygium Surgery: A Case Series

Introduction: Conjunctival autografting which is the mainstay in the management of pterygium. The conjunctival graft is most commonly harvested superiorly. However, superior bulbar conjunctiva may not be available for harvesting a graft in all cases and it would affect the outcome. This study aims at the efficacy of the inferior bulbar conjunctival grafting without using any suture or glue. Methods: This was a prospective observational study conducted in the Department of Ophthalmology, Pabna Medical College Hospital, Pabna, Bangladesh during the period from January 2019 to December 2020. In our study, we included 100 eyes of 98 patients with primary pterygium who underwent surgical procedures in Pabna Medical College Hospital. Results: A total of 100 cases were included in this case series. Patient’s age ranged from 18 to 83 years (mean 48.08±12.76 years). Total graft dehiscence occurred in 2 eyes (2%), graft retraction in 10 eyes (10%), and recurrence was seen in 1 eye (1%). At 3 months postoperatively, the gain in uncorrected visual acuity ranged from 2-3 lines in the Snellen chart in 9 eyes, symblepharon does not occur in any patient and no other complication was noted. Conclusion: Our study shows that this simple technique for pterygium surgery may prevent the potential risk of bad outcomes of future filtration surgery and overcome the conditions when superior bulbar conjunctiva may not be available for harvesting a graft.

Comparison of Superior and Inferior Limbal Conjunctival Autograft Transplantation in Primary Pterygium Surgery: A Retrospective Analysis

Introduction: Conjunctival autografting is the cornerstone of pterygium treatment. The most typical way to harvest the conjunctival graft is superior. Nonetheless, it is not always possible to harvest a graft from the superior bulbar conjunctiva, which could impact the functionality and result of a subsequent filtering procedure [1]. This study aims to compare the effectiveness of superior conjunctival autografting and inferior conjunctival autografting without using glue or sutures. Methods: This was a prospective observational study conducted in the Department of Ophthalmology, Pabna Medical College Hospital, Pabna, Bangladesh during the period from January 2019 to December 2020. In our study, we included 200 eyes of 198 patients with primary pterygium who underwent surgical procedures in Pabna Medical College Hospital. Results: A total of 200 cases were included in this case series. 100 of them underwent superior limbal conjunctival autograft transplantation (Group A) and 100 of them underwent inferior limbal conjunctival autograft transplantation (Group B). There was one eye with recurrence in both groups, which was not statistically significant; there were two eyes with graft dehiscence in group B and one eye with graft dehiscence in group A. Graft retraction was not statistically significant in 12 cases in group A and 10 cases in group B. The inferior conjunctival autografting techniques are great alternatives with similar results and no increased risk of serious problems in cases where the superior conjunctiva must be maintained. Conclusion: Our findings show that suture-less and glue-free superior or inferior limbal conjunctival autograft is safe, cost-efficient, and successful.

Analysis of the Effect of Preoperative Eye Position Fixation Training in Patients With Pterygium: A Randomized Controlled Trial.

This study evaluated the effect of preoperative ocular fixation training on patients undergoing pterygium surgery. Before pterygium excision, patients were trained to perform eye position fixation training, which is beneficial for surgeons performing microsurgery. The study analysed the effectiveness of preoperative eye position fixation training in patients with pterygium by randomised controlled experimental design. The number of occurrences of self-turning, operation time, self-rating depression scale scores and self-rating anxiety scale scores of the experimental group (EG) were lower than those of the control group (CG). The recurrence rate and the incidence of conjunctival tear and conjunctival suture loosening in the EG were significantly lower than those in the CG. The use of eye fixation training prior to pterygium surgery can facilitate the activities of the surgeon, reduce the operation time, reduce the occurrence of complications and reduce the recurrence rate after the operation. Eye fixation training is worthy of application in patients with pterygium.

Use of Plasma Rich in Growth Factors for Ocular Surface Disorders: A Systematic Review.

Ocular surface disorders (OSDs) can severely affect vision and quality of life. Autologous blood products, such as plasma rich in growth factors (PRGF), are recently available to treat OSDs refractory to traditional therapies. This review aims to summarize the efficacy and safety of PRGF in OSDs. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was established a priori and published on PROSPERO (CRD42024522119). MEDLINE, Embase, and Cochrane Library were searched for primary articles until February 6, 2024. Primary outcomes included slit-lamp examination findings and patient-reported outcomes. Secondary outcomes included visual outcomes and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias and ROBINS-I tools. Twenty-two studies involving 1158 eyes were included. PRGF showed notable improvement in objective and subjective outcomes in OSDs. Comparative studies did not show PRGF to be superior to a standard steroid taper for dry eye disease. However, the use of PRGF was also reported in persistent epithelial defects and corneal ulcerations. In these conditions, there were high rates of complete healing and reduced corneal staining. PRGF has also been reported to improve ocular surface healing and stability when used as an adjunct to refractive and pterygium surgeries. No serious adverse events were reported. PRGF has potential as an effective treatment of OSDs resistant to traditional therapies with minimal safety concerns. Large randomized controlled trials are needed to better evaluate the role of PRGF within the treatment armamentarium for corneal pathologies.

Comparison of bare sclera combined with mitomycin c technique and limbal- conjunctival autograft technique in primary pterygium surgery

Comparison of bare sclera combined with mitomycin c technique and limbal- conjunctival autograft technique in primary pterygium surgery

Intraocular Lens Power and Corneal Topographic Change After Pterygium Surgery

PurposeTo investigate the impact of pterygium excision on intraocular lens (IOL) power calculation and corneal astigmatism. DesignsProspective cohort study MethodsWe enrolled 30 eyes with primary pterygium that underwent pterygium excision with a conjunctival autograft. IOL power calculation and keratometry using the IOL Master 700, along with topographic parameters using the Pentacam Scheimpflug topography system, were performed preoperatively and at 1, 3, 6, and 12 months postoperatively. We analyzed correlations between pterygium length/area and IOL power, as well as corneal topographic changes. ResultsThe mean pterygium length was 2.08 ± 0.58 mm, and the mean area was 6.05 ± 2.41 mm2. One year after pterygium surgery, the calculated IOL power values using all formulas were lower than the preoperative values. Pterygia with a horizontal length of 1.73 mm and an area of 4.45 mm2, and those with a horizontal length of 2.25 mm and an area of 6.95 mm2 created 0.5 D and 1.0 D errors in calculated IOL power, respectively (p<0.001). The calculated IOL power values changed significantly from preoperative to six months postoperatively but did not change significantly from six to 12 months postoperatively. Pterygia with a horizontal length greater than 1.83 mm (p<0.001) and an area greater than 5.1 mm2 (p < 0.001) created a 2.0 D error in anterior corneal astigmatism. ConclusionsPterygium causes errors in IOL power calculation, with greater pterygium length/area exerting a larger effect. Cataract surgery with IOL implantation is recommended at least six months after pterygium surgery. In combined case, calculated IOL power should be decreased by 0.5-1.5 D based on the pterygium length/area.

Ocular Mucous Membrane Pemphigoid Presenting as Recurrent Pterygium.

The aim of this series was to report recurrent pterygium as a presenting feature of ocular mucous membrane pemphigoid (oMMP). A retrospective review was performed, and patients with biopsy positive oMMP who presented with recurrent pterygia were included. Data on the demographic profile, clinical characteristics, and details of the surgical intervention were collected. A total of 5 patients with recurrent pterygium were included. All the patients were men. The median age was 63 years. History of pterygium surgery was present in 8/10 eyes (80%), of which 6 eyes (60%) developed a recurrent pterygium. A symblepharon was present in 4/6 eyes (67%). Forniceal shortening was present in 10/10 (100%) eyes. All eyes were subjected to a conjunctival biopsy for direct immunofluorescence, of which 9 eyes (90%) had positive results consistent with oMMP. Systemic immunomodulatory therapy (IMT) with either methotrexate or azathioprine was initiated in all 5 patients. Recurrent pterygium can be a presenting feature of oMMP. The presence of symblepharon formation or forniceal shortening, especially in the fellow eye, warrants a conjunctival biopsy and prompt initiation of IMT to prevent disease progression.

Comparison of the effects of 0.05% topical cyclosporine A versus 0.1% topical cyclosporine A on recurrence and clinical parameters following pterygium surgery.

To compare the efficacy of topical 0.05% cyclosporine A (CsA) and 0.1% topical cyclosporine A (CsA) over a 6-month period following pterygium surgery, specifically evaluating their effects on postoperative recurrence and clinical parameters. This clinical study enrolled 245 patients with pterygium who underwent surgery using the conjunctival autograft technique with mitomycin C (MMC) were enrolled. Participants were divided into three groups: Group 1 (0.05% CsA) (n = 80), Group 2 (0.1% CsA) (n = 80), and a control group (n = 85). They were examined at postoperative first day, first week, first month and sixth month. The examination included best corrected visual acuity (BCVA), intraocular pressure (IOP), presence of inflammation, and ptergium recurrence, all of which were compared across the groups. The mean age of the patients was 63.22 ± 9.39 years, with 53.3% male and 46.7% female. The three groups were similar in terms of demographic characteristics and pterygium size. Inflammation in surgical area significantly regressed in all groups at 6 months postoperatively (p < 0.05). Inflammation in the first and sixth months was not different between the groups (p = 0.118, p = 0.580, and p = 0.435, respectively). The recurrence rate was not different between groups (p = 0.890). There was no statistically significant difference between groups regarding IOP (p = 0.818). A significant increase in BCVA after surgery was observed in three groups compared to preoperative levels (p < 0.05). This study showed that there was no difference between the efficacy of 6 month topical 0.05% CsA and 0.1% CsA application after pterygium surgery with the conjunctival autograft technique with MMC on postoperative outcomes. Including postoperative recurrence, IOP changes, BCVA changes and surgical area inflammation.

Prospective Study: Utility of Anterior Segment Optical Coherence Tomography to Identify Predictive Factors of Recurrence in Pterygium Surgery.

Background/Objectives: The main purpose of this study is to determine, by anterior segment optical coherence tomography (AS-OCT), the anatomical characteristics, both preoperatively and postoperatively, that correlate with a higher rate of pterygium recurrence after surgery with exeresis and conjunctival autograft with biological glue. Methods: A total of 50 eyes which were listed for primary pterygium surgery at an ophthalmology tertiary centre were treated with standard pterygium excision and a conjunctival autograft with tissue glue. Ten variables were measured with AS-OCT (Casia 2; Tomey Corp., Nagoya, Japan) during six control visits with all patients. Finally, statistical analysis was performed using SPSS (SPSS stadistics®, IBM®, version 21.0.0.0) for descriptive variables and R-project (The R foundation©, version 3.0.2) for the rest of the analyses, including a descriptive analysis and an inferential analysis studying prognostic factors of recurrence and their predictive capacity. Results: Among the 50 patients who underwent surgery, recurrence was detected in 8 cases (rate 16%; 95% CI: 5.8-26.2%). Most cases (n = 6) were detected 3 months after surgery. The pattern of recurrences was atrophic in two thirds of the cases; none required reintervention. Preoperative total conjunctival thickness at 3 mm was significantly increased in patients who developed recurrence. One week after surgery, epithelial and stromal thickness at 1 mm and total thickness at 3 mm proved to be useful for predicting recurrence. Both models have significant discriminant capacity. Conclusions: By imaging the graft with AS-OCT preoperatively and 7 days after surgery, the risk of future recurrence can be predicted.

Assessment of conjunctival autograft reperfusion after pterygium surgery by optical coherence tomography angiography (OCT-A)

PurposeTo investigate the healing process of conjunctival autografts (CAG) following pterygium surgery using optical coherence tomography angiography (OCTA). MethodsTwenty-one eyes of 21 patients diagnosed with pterygium underwent pterygium excision with CAG without using Mitomycin-C. Over a 12-week follow-up period, changes in vascular density (VD), vascular density index (VDI), and vascular length density (VLD) were assessed at two distinct depths: superficial (<200 μm) and deep (>200 μm) using OCTA. Additionally, the revascularization rate and pattern were evaluated. ResultsDuring the first week, the CAG was edematous and no sign of neovascularization was observed. In 4th week edema decreased and early signs of vascular formation appeared. In the 12th week, the deep vasculature demonstrated a greater density of interconnectivity compared to the superficial layers. VD and VLD significantly increased during the follow-up period (P < 0.05). The CAG blood flow signals exhibited a chaotic pattern, deviating from the expected centrifugal vascular pattern in the surrounding normal conjunctiva. ConclusionOCTA imaging emerges as a reliable tool for the assessment of CAG vascularization, improving the monitoring of the healing process in the postoperative period. The evaluation of CAG revascularization patterns appears to be promising biomarkers that can predict the potential future recurrence.

The Role of 20% Ethanol in Enhancing Pterygium Surgery Outcomes: A Clinical Study.

Introduction Pterygium is an ocular surface disorder characterized by a hyperplastic growth of conjunctiva encroaching over the cornea. It causes redness, watering, and foreign body sensation. Surgical excision is the preferred mode of treatment when there is encroachment over the visual axis, chronic irritation, restricted ocular motility, and cosmetic concerns. Various surgical methods have been adopted for the treatment and to prevent recurrences. This study assessed the effectiveness and safety of 20% ethanol as an adjuvant in pterygium excision with conjunctival autograft implantation, evaluating surgical outcomes. Methods A prospective hospital-based interventional study was conducted among 30 patients with pterygium from August 2022 to December 2023. Patients were evaluated preoperatively for anterior segment, posterior segment, visual acuity, and corneal astigmatism. Pterygium was excised using 20% ethanol as an adjuvant, and conjunctival autograft was placed over the bare sclera without sutures. Patients were evaluated on postoperative days 1, 8, 30, and 90 for graft condition, visual acuity, corneal astigmatism, and associated complications. Results After three months of follow-up, the mean visual acuity improved to LogMAR 0.46±0.35 (p=0.001), which was statistically significant, and the average corneal astigmatism decreased from 3.36±2.87 to 0.87±0.57 (p=0.0001). No recurrence was noted among the participants. Conclusion This study has shown that using 20% ethanol as an adjuvant for pterygium excision facilitated clean dissection of a pterygium from the underlying cornea and the pterygium-induced corneal astigmatism has significantly decreased, which led to progress in vision.

Z-shaped incision without epithelial resection in pterygium surgery.

To introduce a novel surgical technique using a Z-shaped incision without epithelial resection in ophthalmic pterygia. This was a prospective study. During pterygium surgery, all proliferative tissues were separated from the cornea and conjunctiva without resection of the tissues. The unaffected conjunctiva was incised in a Z-shape. The upper (or lower) conjunctival flap was sutured to the lower (or upper) normal conjunctiva on the limbal sclera, while the proliferative tissue was sutured to the upper conjunctiva (or lower) near the fornix. Ten patients with pterygia were eligible for this study. Eight patients with primary pterygia and 2 with recurrent pterygia were included. The age of patients at surgery ranged from 47 to 90y (average: 71.9y). Five patients each showed right and left-sided pterygia. The postoperative follow-up periods were from 8 to 78mo (average: 25.0mo). The surgery was successfully conducted and wounds were favorably reconstructed in all patients. The proliferative tissues sutured to the normal conjunctiva showed palor and attenuated neovessles, and never showed re-growth after surgery. Nine patients did not show recerrence. Recerrent pterygium was noted in 1 patient, but additional treatments were not required. The procedure involves the reconstruction of pterygial tissue and normal conjunctiva using a Z-shaped incision. The scleral limbal wound can be covered with non-affected conjunctiva without any excision of conjunctival epithelia in patients with primary or recurrent pterygia.

Comparative study of pterygium excision with suture and sutureless conjunctival autograft

Introduction and aim. This is a prospective interventional study to compare corneal astigmatism before and after pterygium excision with conjunctival autograft, to determine the difference in mean corneal curvatures before and after pterygium excision, to evaluate the safety and efficacy of autologous blood technique, and sutured conjunctival autograft for primary pterygium. Material and methods. Patients were divided into group A – pterygium excision+sutured conjunctival limbal autograft and group B – pterygium excision+autologous conjunctival limbal autograft under local anesthesia. The preoperative and post operative K1 and K2 values and BCVA were noted. Results. There was statistically significant reduction in mean astigmatism at each post operative follow up in group A at 1 week (p=0.0249), 2 weeks (p=0.004), 1 month (p=0.0031) and at 3 months (p=0.0009) and similarly in group B post operative follow up at 1 week (p=0.0011), 2 weeks (p=0.0021), 1 month (p=0.0009) and at 3 months (p=0.0003). Conclusion. Pterygium surgery decreases the cylindrical error and reverts corneal curvatures to normal, thus improving subjective visual acuity. Astigmatism produced by the pterygium is reduced after surgery We found autologous conjunctival autograft is superior than sutural conjunctival autograft. Pterygium causes astigmatism depending upon the size of pterygium it should be surgically removed to prevent obstruction in the vision.

The effect of cyclosporine a in pterygium surgery using fibrin glue.

To evaluate the effect of topical cyclosporine A (CsA) 0.05% in patients with pterygium surgery using fibrin glue (FG). Patients with primary nasal pterygium were retrospectically analyzed and categorized into two groups: Group 1 with 41 eyes from 38 patients as a control group and group 2 with 39 eyes from 36 patients who received topical CsA twice a day for 6months. Patients were assessed for recurrence rate, tear film parameters, side effects, and complications at postoperative intervals of 1-7days; 1st, 3rd, 6th and 12th months. The follow-up period was 1year. The two groups were age (p = 0.934) and sex (p = 0.996) matched. CsA drop was discontinued in one patient due to burning sensation and conjunctival hyperemia after 1 week. There was no statistically significant difference between the mean preoperative and postoperative 1st year Schirmer I and tear break-up time (TBUT) values in group 1 (p = 0.136; p = 0.069). Although the difference between the mean preoperative and postoperative 1st year TBUT values in group 2 was not statistically different (p = 0.249), Schirmer I results were higher postoperatively (p = 0.003). There was no statistically significant difference between preoperative Schirmer (p = 0.496), postoperative Schirmer (p = 0.661), preoperative TBUT (p = 0.240) and postoperative TBUT (p = 0.238) results of the two groups. Recurrence was observed in only one patient from group 1. No recurrent pterygium cases were observed in group 2. Schirmer I values were higher postoperatively in group 2; thus,topical CsA treatment may improve lacrimal secretion and be effective after pterygium surgery with FG.

Comparison of postoperative topical interferon-α2b versus intraoperative mitomycin C for pterygium recurrence prevention: a randomized clinical trial.

To evaluate the effect of postoperative interferon-alpha 2b (IFN-α2b) ophthalmic drops versus intraoperative mitomycin-c (MMC) on preventing pterygium recurrence. This prospective randomized clinical trial was conducted on patients who were candidates for pterygium surgery. A total of 75 patients were included in the study from December 2021 to December 2022, of which 64 patients (one eye each) were examined and analyzed based on the inclusion criteria. Then the patients were randomly assigned to control groups, intra-operative MMC (32 patients) and the intervention group, IFN-α2b drops after the operation (32 patients). All patients underwent pterygium surgery using the rotational conjunctival flap method. In terms of pterygium grading, 8 (12.5%), 25 (39.06%), and 31 (48.44%) eyes were in grades 1, 2, and 3, respectively. The average size of the pterygium was 3.6 ± 0.7mm. The grade and size of pterygium had the same distribution in the two groups. There was no statistically significant difference between the two groups in the level of post-operative clinical inflammation. The present study showed no significant difference in complications between the two groups (p = 0.999). The recurrence rate in the control group was 9.4% (3 eyes), and 0% (no recurrence) in the intervention group (p = 0.119). interferon-alpha 2b group did not show a statistically significant difference in preventing pterygium recurrence compared to the mitomycin C group. The post-surgery administration of IFN-α 2b drops can effectively prevent pterygium recurrence with a comparable and even more compelling effect than MMC during surgery.

Dehydrated Amniotic Membrane in Pterygium Surgery

Dehydrated Amniotic Membrane in Pterygium Surgery

Intermittent sliding-lock-knot suture for limbal conjunctival autograft fixation in pterygium surgery: a technique note.

To report a technique used with intermittent sliding-lock-knot (ISLK) fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine intermittent (RI) fixation. Consecutive patients with primary pterygium who had undergone pterygium excision combined with limbal conjunctival autograft transplantation between March 2021 and March 2022 at our institute were retrospectively analyzed. Primary outcome measures were mean duration of surgery and suture removal, degree of conjunctival hyperemia on postoperative day 1, pain score at suture removal, postoperative symptoms at 6mo, including conjunctival hyperemia, foreign body sensation, and graft stability. Ninety-eight patients underwent monocular surgery and were divided into ISLK (51 eyes) and RI (47 eyes) groups according to the type of conjunctiva autograft fixation method planned. There was no significant difference in mean duration of surgery between the two groups (18.59±2.39min vs 18.15±2.20min, P=0.417); however, compared to the RI group, shorter suture removal times were observed in the ISLK group [0.58min (0.42-0.87) vs 3.00min (2.21-4.15), P<0.001]. The degree of conjunctival hyperemia on postoperative day 1 was milder in the ISLK group (P<0.001). Pain scores at suture removal were lower in the ISLK group than in RI group [1 (0-3) vs 2 (1-4), P<0.001]. Postoperative symptoms at 6mo were comparable between the groups (P=0.487), with no recurrence. ISLK is an innovative method for limbal conjunctival autograft fixation after pterygium excision. Compared to RI fixation, ISLK facilitates suture removal and reduces discomfort, with comparable surgery duration and less conjunctival hyperemia.

Timing optimization for primary pterygium excision with conjunctival-limbal autograft to restore the corneal optical properties.

To propose the optimal value of baseline corneal astigmatism and pterygial morphological profiles for primary pterygium surgery to restore the corneal optical properties. We analysed 93 eyes from 84 subjects with nasal-only primary pterygium who underwent pterygium excision with conjunctival-limbal autograft and were assessed perioperatively using anterior segment swept-source optical coherence tomography (AS SS-OCT). We collected data on anterior corneal astigmatism (ACA) and root mean square (RMS) values for anterior corneal lower- (LoA) and higher-order aberrations (HoA) as corneal optical properties using AS SS-OCT. Using preoperative ACA and four pterygial morphological profiles (horizontal invasion length [HIL], height, thickness and the ratio of residual corneal thickness [RCT] to central corneal thickness [CCT]) measured in AS SS-OCT, we plotted receiver operating characteristic (ROC) curves. These curves aimed to determine cut-off values predicting a perioperative decrease exceeding 50% in ACA, RMS LoA and RMS HoA, as well as postoperative residual ACA higher than 1.25D. Preoperative ACA > 1.42D (AUC = 0.934) and >3.60D (AUC = 0.946) proved most effective in identifying subjects with perioperative decrease exceeding in ACA and RMS LoA, respectively. HIL > 3.34 mm (AUC = 0.941) was most effective in distinguishing subjects with perioperative reduction exceeding 50% in RMS HoA. Preoperative ACA > 5.78D (AUC = 0.776) and HIL > 5.03 mm (AUC = 0.700) significantly distinguished subjects with postoperative residual ACA higher than 1.25D. Optimizing the restoration of corneal astigmatism and aberrations after pterygium surgery may be facilitated by determining the optimal surgical timing based on preoperative ACA and HIL values.

Importance of Higher-Order Aberrations on Both Anterior and Posterior Surfaces After Pterygium Surgery.

The purpose of this study was to investigate the changes in higher-order aberrations (HOAs), coma, and spherical aberrations (SAs) on the anterior, posterior, and total corneal surfaces after pterygium excision. In this single-center study, we examined 19 eyes of 15 patients who underwent pterygium excision at Yokohama Minami Kyosai Hospital between January 2017 and December 2017. We also evaluated 25 eyes of 25 age-matched patients with no history of ocular disease as the control group. Corneal topography, total HOAs, coma, and SAs in all regions at 4 and 6 mm diameters were evaluated using anterior segment optical coherence tomography (CASIA SS-1000, Tomey, Japan). The pterygium area and extent were also assessed. Significant improvements in the HOAs, coma, and SAs at both diameters were observed in the total and anterior corneas from the first postoperative month. Notably, the posterior cornea showed significant improvements in HOAs (4 mm: P < 0.001 [log HOAs]; 6 mm: P = 0.001 [log HOAs]) and coma (4 mm: P = 0.003 [log coma], 6 mm: P = 0.002 [log coma]) within both diameters at 1 month postoperatively. A strong correlation was identified among the pterygium area, posterior HOAs, and coma (Spearman correlation = 0.651). Pterygium induced 2 D of astigmatism when extension exceeded 2.1 mm. HOAs in both the anterior and posterior corneas improved after pterygium excision. This finding underscores the importance of considering corneal aberrations on both anterior and posterior surfaces in pterygium management.