Preoperative systemic inflammatory indices and tear film parameters as predictors of pterygium recurrence: A matched case-control study

Abstract

Purpose

To evaluate whether preoperative systemic inflammatory indices and tear film parameters predict pterygium recurrence after conjunctival autograft (CAG) surgery.

Methods

This retrospective matched case-control study included 94 eyes (47 with recurrence, 47 controls) matched for age, sex, and pterygium grade. Preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII) were calculated from complete blood counts. Tear breakup time (TBUT) and Schirmer I test assessed ocular surface function. Between-group differences and logistic regression identified independent predictors, while receiver operating characteristic (ROC) analysis evaluated discriminative performance.

Results

Patients with recurrence had higher NLR (median 2.5 vs. 1.9, p < 0.001) and SII (600 vs. 450 × 10³, p < 0.01), whereas PLR and MLR showed no significant differences. Tear film parameters were worse in recurrence cases: TBUT (5.0 vs. 8.0 s, p < 0.001) and Schirmer I (8 vs. 12 mm, p = 0.02). Multivariate analysis identified elevated NLR (≥2.0; OR 4.2, 95% CI 1.4–12.8) and reduced Schirmer I (≤10 mm; OR 3.0, 95% CI 1.1–7.9) as independent predictors.

Conclusions

Elevated systemic inflammation and impaired tear function independently predict pterygium recurrence. Incorporating these markers may guide individualized risk assessment and postoperative management.