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.