Characteristics and risk factors of recurrent pterygium underwent excision combined with limbal conjunctival autograft in southern rural China

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Background Pterygium is a prevalent ocular surface disorder globally. Postoperative recurrence poses a significant challenge to clinical management. Current evidence regarding recurrence risk factors is predominantly derived from urban populations. This study aimed to investigate the specific risk factors for pterygium recurrence within a remote population in Southern China. Methods This retrospective, institution-based case series analyzed 200 patients who underwent primary pterygium excision combined with limbal-conjunctival autograft between January 2016 and February 2022. Patients were stratified into recurrent and non-recurrent groups based on postoperative outcomes. Cumulative recurrence rates were estimated using Kaplan–Meier survival analysis. Multivariate binary logistic regression was performed to identify independent risk factors for recurrence. Results The mean time to recurrence was 42.21 ± 22.13 months, with a median recurrence-free survival of 72.0 months. Compared to the non-recurrent group, patients in the recurrent group were significantly older (67.62 ± 5.79 vs. 60.27 ± 10.33 years, p < 0.001), had lower educational attainment (41.4% vs. 66.1%, p = 0.013), reported longer durations of daily sunlight exposure (5.79 ± 1.01 vs. 4.80 ± 2.17 h, p < 0.001) and exhibited poorer preoperative best-corrected visual acuity (0.98 ± 0.75 vs. 0.57 ± 0.60 logMAR, p < 0.001). Multivariate analysis confirmed advanced age at onset as the sole risk factor of recurrence ( p = 0.007). Conclusion In rural southern China, pterygium recurrence is distinguished by a delayed onset pattern. Our findings highlight advanced age as a robust independent risk factor in this region, necessitating a shift in clinical focus. Management strategies in underserved areas should prioritize elderly patients through extended follow-up periods and targeted health education to mitigate recurrence risks.

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