Mind The Flap: Surgical Challenges Of Recurrent Pterygium Post-Lasik

To describe the surgical management and outcomes of recurrent nasal pterygium in a post-LASIK eye. This case highlights the unique surgical challenges caused by altered corneal anatomy, the risk of LASIK flap compromise, and the need for tailored techniques to preserve corneal integrity, restore vision, and prevent recurrence.

Tertiary care hospital: Hospital Universitario 12 de Octubre, Madrid, Spain. The case was managed by the cornea and anterior segment unit, addressing both the recurrent pterygium and the pre-existing LASIK flap to ensure functional and cosmetic recovery.

A 58-year-old male presented with recurrent nasal pterygium in the left eye, previously treated with pterygium excision and LASIK. The pterygium adhered to the nasal edge of the LASIK flap, creating irregularity and reduced visual acuity (BCVA 0.7) with irregular astigmatism. Surgical management required delicate dissection to excise the pterygium and Tenon’s tissue while preserving the LASIK flap. The corneal bed was smoothed, and a conjunctival autograft from the superior conjunctiva was applied using fibrin glue to ensure complete coverage. On initial follow-up, a vertical macrostria appeared within the LASIK flap due to intraoperative manipulation. A secondary procedure was required: flap relifting, epithelial debridement with alcohol, and careful repositioning. A therapeutic contact lens was placed for stabilization. At 6 months, BCVA improved to 1.0 with stable refraction (+0.50 -1.25 x 2º) and regular topography. No recurrence was detected, and the patient reported significant visual and cosmetic improvement. Strict photoprotection and lubrication were recommended.

Recurrent pterygium after LASIK presents complex surgical challenges, requiring careful flap preservation and customized surgical strategies. Combining precise pterygium excision, conjunctival autograft with fibrin glue, and proactive flap management can restore visual function, maintain refractive stability, and prevent recurrence, ensuring optimal long-term outcomes.