Abstract
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.