Background: Recurrence is a common complication of pterygium excision. This study has objective to evaluate the efficacy of topical 0.2% loteprednol etabonate, a ‘soft steroid’, compared to topical 0.1% dexamethasone widely used in postoperative pterygium excision to prevent the recurrence of pterygium.

Methods: Randomized control trial study, patients undergoing pterygium excision with amniotic membrane transplantation who developed impending recurrent pterygium stage 3 were randomized into 2 groups. Group 1 received 0.2% loteprednol etabonate and group 2 received 0.1% dexamethasone. The rate of true recurrence of pterygium, impending recurrent pterygium scores, and intraocular pressure were compared between the groups.

Results: Fifty-four eyes of 54 patients in each group were included. The true recurrence of pterygium in between groups was not significantly different (15 patients [27.8%] in group 1 vs. 17 patients [31.5%] in group 2, p = 0.67). However, the time to recurrence ± SD was longer in group 2 than in group 1 (3.35 ± 1.7 vs. 1.47 ± 0.8 months, respectively, p = 0.0002). Scores of impending recurrent pterygium at 1 month and 6 months were not significantly different between both groups (p =0.26 and p = 0.1, respectively), but were significantly higher in group 2 at 3 months (p = 0.015). No ocular hypertension was found in group 1, but found 6 patients (11.1%) in group 2.

Conclusions: This study found the efficacy of 0.2% loteprednol etabonate was non-inferior to 0.1% dexamethasone in preventing the recurrence of pterygium and controlling inflammation after pterygium excision with more safety to avoid steroid-induced ocular hypertension.