Supplementary Material for: An Individualized Surgical Approach for the Management of Recurrent Pterygium: A Case Report

Background:
This case highlights the complexity of managing highly refractory, recurrent pterygium. Despite numerous prior surgeries by experienced anterior segment surgeons, the patient developed persistent fibrosis, symblepharon formation, and functional limitations. This underscores the need for a tailored, multidisciplinary approach, a strategy not widely documented in current literature.
Case Presentation:
Over six years, the patient underwent ten previous interventions, including conjunctivoplasty with ipsilateral free conjunctival flap and mitomycin C (MMC), amniotic membrane transplantation, symblepharolysis, and tenonplasty. The most recent surgery had been performed six months before referral to our clinic. Despite these attempts, each procedure was followed by significant fibrosis, scarring, recurrent symblepharon formation involving the fornices.
Following comprehensive multidisciplinary discussion and literature review, reconstructive surgery was undertaken. This included conjunctivoplasty with a free limbal-conjunctival autograft from the contralateral eye, adhesiolysis of the extraocular muscles, muscle belly plasty with amniotic membrane grafting, and placement of barrier sutures to reduce adhesion recurrence.
During 12 months of follow-up, the patient exhibited notable clinical improvement, including enhanced ocular motility, resolution of diplopia in primary gaze, and improved visual acuity.
Conclusions:
This case emphasizes the importance of individualized, innovative surgical planning for advanced recurrent pterygium. A long-term, multidisciplinary strategy can offer sustained anatomical and functional restoration in patients with extensive prior surgical failure and severe ocular surface disease.

背景：
本病例凸显了难治性复发性翼状胬肉（pterygium）管理的复杂性。尽管经验丰富的眼前节外科医师已为患者实施过多次手术，但患者仍出现持续性纤维化、睑球粘连形成及功能受限。这凸显了采用个体化多学科诊疗方案的必要性，而此类策略在当前文献中鲜有记载。

病例介绍：
六年间，该患者先后接受了10次手术干预，包括同侧游离结膜瓣结膜成形术联合丝裂霉素C（MMC）、羊膜移植术、睑球粘连分离术及眼球筋膜囊成形术。最近一次手术于转诊至我院前6个月完成。尽管尝试了上述多种术式，但每次术后均出现显著纤维化、瘢痕形成，以及累及穹窿部的复发性睑球粘连。

经全面多学科讨论及文献调研后，我们为患者实施了重建手术，术式包括取自对侧眼的角膜缘结膜游离自体移植、眼外肌粘连松解术、联合羊膜移植的肌腹成形术，以及放置屏障缝线以减少粘连复发。

在12个月的随访期间，患者临床症状显著改善，包括眼球运动功能增强、第一眼位复视消失以及视力提升。

结论：
本病例强调了针对晚期复发性翼状胬肉采用个体化创新性手术方案的重要性。对于既往多次手术失败且伴有严重眼表疾病的患者，长期多学科诊疗策略可实现持久的解剖结构与功能恢复。