{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T05:28:01Z","timestamp":1787290081203,"version":"build-2736575974"},"reference-count":28,"publisher":"Knowledge E DMCC","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["knepublishing.com"],"crossmark-restriction":true},"short-container-title":["JOVR"],"abstract":"<jats:p>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 &gt;3 mm). The patients had been admitted to Amiralmomenin Hospital (Rasht, Iran) in 2023-2024 and were randomized to \u201cgroup A\u201d (IRCF surgery) and \u201cgroup B\u201d (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 &gt; 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 &gt; 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.<\/jats:p>","DOI":"10.18502\/jovr.v21.17916","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T05:14:53Z","timestamp":1787289293000},"page":"1-10","update-policy":"https:\/\/doi.org\/10.18502\/knecrossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Recurrence Rate and Outcomes of Pterygium Surgery with Inferior Versus Superior Rotational Conjunctival Flap: A Randomized Clinical Trial"],"prefix":"10.18502","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9149-9270","authenticated-orcid":false,"given":"Hassan","family":"Behboudi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2469-2681","authenticated-orcid":false,"given":"Mitra","family":"Akbari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9661-3036","authenticated-orcid":false,"given":"Reza Soltani","family":"Moghadam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0461-3859","authenticated-orcid":false,"given":"Hamed","family":"Molaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9195-9094","authenticated-orcid":false,"given":"Ehsan Kazemnezhad","family":"Leili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"7770","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"341048","doi-asserted-by":"crossref","unstructured":"1. Chu WK, Choi HL, Bhat AK, Jhanji V. Pterygium: New insights. Eye (Lond) 2020;34:1047-1050.","DOI":"10.1038\/s41433-020-0786-3"},{"key":"341049","doi-asserted-by":"crossref","unstructured":"2. Shahraki T, Arabi A, Feizi S. Pterygium: an update on pathophysiology, clinical features, and management. Ther Adv Ophthalmol 2021;13:25158414211020152.","DOI":"10.1177\/25158414211020152"},{"key":"341050","doi-asserted-by":"crossref","unstructured":"3. Rezvan F, Khabazkhoob M, Hooshmand E, Yekta A, Saatchi M, Hashemi H. Prevalence and risk factors of pterygium: A systematic review and meta-analysis. Surv Ophthalmol 2018;63:719-735.","DOI":"10.1016\/j.survophthal.2018.03.001"},{"key":"341051","doi-asserted-by":"crossref","unstructured":"4. Patel ED, Rhee MK. Surgical techniques and adjuvants for the management of pterygium. Eye Contact Lens 2022;48:3-13.","DOI":"10.1097\/ICL.0000000000000849"},{"key":"341052","unstructured":"5. Akhter W, Tayyab A, Kausar A, Masrur A. Reducing postoperative pterygium recurrence: Comparison of free conjunctival auto-graft and conjunctival rotation flap techniques. J Coll Physicians Surg Pak 2014;24:740-744."},{"key":"341053","doi-asserted-by":"crossref","unstructured":"6. Ghiasian L, Samavat B, Hadi Y, Arbab M, Abolfathzadeh N. Recurrent pterygium: A review. J Curr Ophthalmol 2022;33:367-378.","DOI":"10.4103\/joco.joco_153_20"},{"key":"341054","doi-asserted-by":"crossref","unstructured":"7. Han SB, Jeon HS, Kim M, Lee SJ, Yang HK, Hwang JM, et al. Risk factors for recurrence after pterygium surgery: An image analysis study. Cornea 2016;35:1097-1103.","DOI":"10.1097\/ICO.0000000000000853"},{"key":"341055","doi-asserted-by":"crossref","unstructured":"8. Nuzzi R, Tridico F. How to minimize pterygium recurrence rates: Clinical perspectives. Clin Ophthalmol 2018;12:2347-2362.","DOI":"10.2147\/OPTH.S186543"},{"key":"341056","unstructured":"9. Ali Z, Zafar D, Shafique H, Ikram F, Hanan F, Ullah S. Postoperative outcome in terms of recurrence after pterygium excision with bare sclera technique & sutureless amniotic membrane transplantation technique. Ophthalmology Update 2020;18:9."},{"key":"341057","doi-asserted-by":"crossref","unstructured":"10. Clearfield E, Hawkins BS, Kuo IC. Conjunctival autograft versus amniotic membrane transplantation for treatment of pterygium: Findings from a Cochrane systematic review. Am J Ophthalmol 2017;182:8-17.","DOI":"10.1016\/j.ajo.2017.07.004"},{"key":"341058","doi-asserted-by":"crossref","unstructured":"11. Gudimetla J, Potti S, Shivaprasad S, Bhide M, Prabhakar V. Pterygium surgery using inferior rotational conjunctival autograft versus conventional conjunctival autograft with sutures - A comparative study. Indian J Ophthalmol 2023;71:3646-3651.","DOI":"10.4103\/IJO.IJO_16_23"},{"key":"341059","doi-asserted-by":"crossref","unstructured":"12. Shrestha A, Shrestha A, Bhandari S, Maharjan N, Khadka D, Pant SR, et al. Inferior conjunctival autografting for pterygium surgery: An alternative way of preserving the glaucoma filtration site in far western Nepal. Clin Ophthalmol 2012;6:315-319.","DOI":"10.2147\/OPTH.S29227"},{"key":"341060","doi-asserted-by":"crossref","unstructured":"13. Yeung SN, Lichtinger A, Kim P, Elbaz U, Ku JY, Amiran MD, et al. Superior versus inferior conjunctival autografts combined with fibrin glue in the management of primary pterygia. Cornea 2013;32:1582-1586.","DOI":"10.1097\/ICO.0b013e3182a9e712"},{"key":"341061","doi-asserted-by":"crossref","unstructured":"14. Prabhasawat P, Barton K, Burkett G, Tseng SC. Comparison of conjunctival autografts, amniotic membrane grafts, and primary closure for pterygium excision. Ophthalmology 1997;104:974-985.","DOI":"10.1016\/S0161-6420(97)30197-3"},{"key":"341062","doi-asserted-by":"crossref","unstructured":"15. Kheirkhah A, Nazari R, Nikdel M, Ghassemi H, Hashemi H, Behrouz MJ. Postoperative conjunctival inflammation after pterygium surgery with amniotic membrane transplantation versus conjunctival autograft. Am J Ophthalmol 2011;152:733-738.","DOI":"10.1016\/j.ajo.2011.04.013"},{"key":"341063","doi-asserted-by":"crossref","unstructured":"16. Li W, Lou Y, Wang B. Recurrence rate with inferior conjunctival autograft transplantation compared with superior conjunctival autograft transplantation in pterygium surgery: A meta-analysis. BMC Ophthalmol 2021;21:131.","DOI":"10.1186\/s12886-021-01889-4"},{"key":"341064","unstructured":"17. Celeva Markovska V, Stankovic Babic G, Zdravkovska Jankuloska M. Comparative study of pterygium surgery. Prilozi 2011;32:273-287."},{"key":"341065","doi-asserted-by":"crossref","unstructured":"18. Upadhyaya M, Savur S. Superior versus inferior conjunctival limbal autograft with sutures in the management of primary pterygium in a tertiary care hospital in Dakshina Kannada - A cross-sectional study. J Evid Based Med Healthc 2021;8:603-607.","DOI":"10.18410\/jebmh\/2021\/118"},{"key":"341066","doi-asserted-by":"crossref","unstructured":"19. Chen Q, Li Y, Xu F, Yan Y, Lu K, Cui L, et al. Comparison of inferior and superior conjunctival autograft for primary pterygium. Curr Eye Res 2015;40:786-791.","DOI":"10.3109\/02713683.2014.961612"},{"key":"341067","unstructured":"20. Hu Z, Li T, Ophthalmology D. Curative effect comparison of stem cell transplantation of supprior-inferior autologous corneal limbus in the treatment of pterygium. Int J Ophthalmol 2015;15:1472-1474."},{"key":"341068","doi-asserted-by":"crossref","unstructured":"21. Al Fayez MF. Limbal versus conjunctival autograft transplantation for advanced and recurrent pterygium. Ophthalmology 2002;109:1752-1755.","DOI":"10.1016\/S0161-6420(02)01160-0"},{"key":"341069","doi-asserted-by":"crossref","unstructured":"22. Al Fayez MF. Limbal-conjunctival vs conjunctival autograft transplant for recurrent pterygia: A prospective randomized controlled trial. JAMA Ophthalmol 2013;131:11-16.","DOI":"10.1001\/archophthalmol.2012.2599"},{"key":"341070","doi-asserted-by":"crossref","unstructured":"23. Frau E, Lab\u00e9toulle M, Lautier-Frau M, Hutchinson S, Offret H. Corneo-conjunctival autograft transplantation for pterygium surgery. Acta Ophthalmol Scand 2004;82:59-63.24. Du Z, Jiang D, Nie A. [Limbal epithelial autograft transplantation in treatment of pterygium]. Zhonghua Yan Ke Za Zhi 2002;38:351-354.","DOI":"10.1111\/j.1600-0420.2004.0185.x"},{"key":"341071","unstructured":"25. Young AL, Leung GY, Wong AK, Cheng LL, Lam DS. A randomised trial comparing"},{"key":"341072","doi-asserted-by":"crossref","unstructured":"0.02% mitomycin C and limbal conjunctival autograft after excision of primary pterygium. Br J Ophthalmol 2004;88:995-997.","DOI":"10.1136\/bjo.2003.036830"},{"key":"341073","doi-asserted-by":"crossref","unstructured":"26. Riordan-Eva P, Kielhorn I, Ficker LA, Steele AD, Kirkness CM. Conjunctival autografting in the surgical management of pterygium. Eye (Lond) 1993;7:634-638.","DOI":"10.1038\/eye.1993.146"},{"key":"341074","doi-asserted-by":"crossref","unstructured":"27. Kazanc\u0131 B, \u0130nan\u00e7 \u0130, \u00c7orak Ero\u011flu F, Sabuncuo\u011flu B, \u015een E. The effect of autografts from the inferior and superior bulbar conjunctiva on the ocular surface in primary pterygium surgery: A cytology study. Turk J Ophthalmol 2023;53:336-342.","DOI":"10.4274\/tjo.galenos.2023.64494"},{"key":"341075","doi-asserted-by":"crossref","unstructured":"28. Zloto O, Rosen N, Leshno A, Rosner M. Very long term success of pterygium surgery with conjunctival graft. 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