AIM:To investigate the curative effect of pterygium excision combined with free conjunctival flap transplantation on primary pterygium and the influence on tear film function.

METHODS:Totally 120 patients(126 eyes)with primary pterygium who were admitted to the hospital between January 2018 and October 2019 were selected as the research subjects. They were divided into two groups according to the random number table method. 62 cases(64 eyes)in the conjunctival transplantation group were treated with pterygium excision combined with free conjunctival flap transplantation. 58 cases(62 eyes)in the amniotic membrane transplantation group were treated with pterygium excision combined with amniotic membrane transplantation. The length of Schirmer's-Ⅰ test(SⅠt), tear film break-up time(BUT), corneal fluorescein staining(FL)scores, noninvasive Keratograph tear breakup time(NIBUT), determine tear river height(TMH)and conjunctival goblet cell count were determined before surgerry, at 3mo and 6mo after surgery. Patients' quality of life was evaluated with ocular surface disease index(OSDI), and the therapeutic effect and recurrence were evaluated at 6mo after surgery.

RESULTS: There was no significant difference in the average repair time of corneal epithelium or the duration of symptoms between the conjunctival transplantation group and the amniotic membrane transplantation group(P>0.05). At 6mo after surgery, the BUT \〖(11.11±2.77)s vs(10.01±2.41)s\〗, NIBUT \〖(10.01±1.52)s vs (9.52±0.98)s\〗 in conjunctival transplantation group was longer than that in the amniotic membrane transplantation group(P<0.05), and the FL score was lower than the amniotic membrane transplantation group \〖(0.44±0.10)points vs(0.50±0.11)points\〗(P<0.05). The conjunctival goblet cell counts in both groups were increased significantly after surgery(P<0.05). At 3mo and 6mo after surgery, the counts in conjunctival transplantation group were larger than those in the amniotic membrane transplantation group \〖(311.41±58.45)/mm² vs(285.46±68.96)/mm²,(342.41±66.89)/mm² vs(314.41±70.12)/mm²\〗(P<0.05). The OSDI scores of both groups were significantly decreased after surgery(P<0.05), but there was no significant difference between groups(P>0.05). There was no statistically significant difference in the overall curative effect between the two groups(P>0.05). The recurrence rates in the conjunctival transplantation group and the amniotic membrane transplantation group were 6.3% and 6.5%, respectively(P>0.05).

CONCLUSION: Pterygium resection combined with autologous conjunctival flap transplantation is equivalent to amniotic membrane transplantation in terms of postoperative recovery and prevention of pterygium recurrence. Both can improve the stability of patients' tear film function.