Adjuvant Use of Topical 0.05% Cyclosporine A in Primary Pterygium Recurrence Rate: A Systematic Review and Meta-analysis.

Abstract

To assess pterygium recurrence rates across various surgical techniques utilizing topical 0.05% cyclosporine A (CsA) as an adjuvant therapy versus surgical techniques alone in a meta-analysis. We searched PubMed, Cochrane Database, Embase, and Web of Science for trials that compared pterygium recurrence rates between excision surgery with adjuvant 0.05% CsA and excision surgery alone. Risk of bias was assessed using ROBINS-I and RoB-2 tools. The protocol was prospectively registered in the International Prospective of Systematic Reviews (PROSPERO) under protocol number CRD42025644690. Statistical analysis was performed using Review Manager 5.4.1. We included 12 studies (893 eyes) with follow-up periods of 6 and 12 months. A total of 448 eyes (50.22%) with pterygium were treated with adjuvant 0.05% CsA. Most patients were over 50 years of age, with the majority being male. The pterygium recurrence rate at last follow-up (OR = 0.32; 95% CI [0.22, 0.47]; P < .00001) was lower in eyes treated with excision surgery and adjuvant 0.05% CsA compared to excision surgery alone. Subgroup analyses demonstrated statistically significant reductions in pterygium recurrence rate for randomized clinical trials (RCTs) (OR = 0.33; 95% CI [0.21, 0.52]; P < .00001), bare sclera (OR = 0.20; 95% CI [0.12, 0.36]; P < .00001), and conjunctival flap rotation (CFR) (OR = 0.43; 95% CI [0.20, 0.91]; P = .03). Similarly, statistically significant effects were observed for different posology regimens of 0.05% CsA: once daily (OR = 0.16; 95% CI [0.05, 0.46]; P = .0007), twice daily (OR = 0.36; 95% CI [0.15, 0.83]; P = .02), and more than twice daily (OR = 0.35; 95% CI [0.19, 0.65]; P = .0008). The recurrence rates with rotational conjunctival autograft (RCAG) and limbal conjunctival autograft (LCAG) techniques did not reach statistical significance (P = .12). Adjuvant topical 0.05% CsA appears effective in reducing pterygium recurrence rates following bare sclera and CFR surgical techniques, but not after RCAG or LCAG excision. Additional research is needed to clarify the most effective dosing strategy.