Objective/Purpose
To compare the safety and preliminary efficacy of platelet-rich fibrin membrane (PRFm) versus conjunctival autograft (CA) for primary pterygium surgery.
Design
Prospective, comparative, non-randomized pilot study.
Subjects, Participants, and/or Controls
This pilot study enrolled 141 patients (76 Group A/CA; 65 Group B/PRFm) undergoing primary pterygium surgery between February 2024 and April 2025. Patients selected their preferred treatment approach.
Methods, Intervention, or Testing
Primary outcome was pterygium recurrence at 12 months (Solomon grading scale). Secondary outcomes included conjunctival inflammation (Efron scale), ocular surface symptoms (Visual Analog Scale and Ocular Surface Disease Index), corneal epithelialization time, visual acuity, surgical time, and graft integration (AS-OCT imaging).
Results
Recurrence occurred in 7 eyes (9.2%; 95% CI 3.8–17.8%) in Group A and 1 eye (1.5%; 95% CI 0.0–8.2%) in Group B. Mean surgical time was substantially shorter with PRFm (18.2 ± 5.2 min versus 38.5 ± 7.1 min; 53% reduction; p < 0.001). Conjunctival inflammation was consistently lower in Group B through 3 months (p < 0.001 at 1 month), with resolution in both groups by 12 months. Within-group improvements in symptom scores were substantially greater with PRFm (VAS frequency 88.6% decrease versus 41.5%; OSDI 44.2% decrease versus 18.6%), with PRFm crossing from moderate to mild symptom category. However, between-group comparisons at individual postoperative timepoints demonstrated no statistically significant differences in symptom outcomes (all p > 0.05). AS-OCT measurements were comparable between groups at all timepoints, with no significant associations between graft morphology and clinical outcomes. Both procedures demonstrated excellent safety profiles with no serious adverse events.
Conclusions
This pilot study suggests PRFm may offer operational advantages and potentially favorable preliminary trends in recurrence and symptom improvement compared with CA for primary pterygium surgery. These exploratory findings warrant investigation in a larger randomized controlled trial with adequate power to determine whether observed trends represent clinically meaningful advantages.
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