In vivo confocal microscopy findings about ocular surface recovery in patients following pterygium excision combined with conjunctival autograft

Purpose To study cellular and neural changes around the donor and recipient areas after pterygium excision combined with autologous conjunctival transplantation using corneal confocal microscopy, we evaluated the postoperative impact of this surgical procedure. Methods Patients with primary pterygium located on the nasal side who visited the Department of Ophthalmology of Wuxi Second People's Hospital between April and August 2023 were enrolled. Age-matched healthy eyes were included as the control group. IVCM was performed in the affected eyes, 6 months after pterygium excision. The images of the central conjunctival cells in the recipient and donor areas, the cells of each layer of the cornea around the recipient and donor area (around 2 mm from the nasal and upper corneal margins), and the structures of the corneal margins were recorded in the affected eyes and statistically compared with the corresponding areas in the control eyes. Results Seventeen eyes of 14 patients with primary pterygium located on the nasal side (mean 64 +/- 8.74 years old), and 17 eyes of nine patients as age-matched normal controls were included. Compared with those of normal eyes, the density of corneal pterygoid epithelium around the recipient area (5104 +/- 599 cells/mm(2) vs. 5700 +/- 515 cells/mm(2), P < 0.01) and the central conjunctival epithelial cells in the recipient areas (3984 +/- 453 cells/mm(2) vs. 4834 +/- 244 cells/mm(2), P < 0.01) were significantly lower 6 months postoperatively. However, the superficial stromal, deep stromal, and endothelial cell densities around the recipient area exhibited no significant differences (P > 0.05). Highly illuminated basal cells were visible at the nasal corneal margin, with an irregular intersection of fibrous tissue with corneal epithelial cells. More dendritic Langerhans cell infiltration was seen in the junctional area. Compared with those in the normal eyes, the densities of the corneal pterygoid epithelium (4896 +/- 428 cells/mm(2) vs. 5557 +/- 367 cells/mm(2), P < 0.01), deep stromal cells (337 +/- 65 cells/mm(2) vs. 419 +/- 39 cells/mm2, P < 0.01), endothelial cells (2305 +/- 170 cells/mm(2) vs. 2547 +/- 212 cells/mm(2), P < 0.01) around the donor area and the central conjunctival epithelial cells (3700 +/- 446 cells/mm(2) vs. 4282 +/- 272 cells/mm(2), P < 0.01) in the donor area were significantly lower 6 months postoperatively. However, no significant differences were observed in superficial stromal cell density (P > 0.05). A slight wavy interfacial intersection was visible on the superior corneal margin, with some of the highlighted basal cells visible. Conclusions Pterygium excision combined with autologous conjunctival transplantation with corneal stem cells can better promote the repair of most corneal cells around the recipient area and fence-like structures of the corneal rim 6 months postoperatively, but there may be some damage to the corneal conjunctival structures around the donor area.