What is truly evidence-based in pterygium? An umbrella review of systematic reviews and meta-analyses.

PURPOSE: To synthesize and critically appraise evidence from systematic reviews and meta-analyses on pterygium, identifying domains with robust support and those that remain heterogeneous or insufficiently developed. METHODS: An umbrella review of systematic reviews, meta-analyses, and network meta-analyses was conducted. Searches were performed in PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus, with an additional manual search. The final search was completed on March 22, 2026. Eligible studies addressed key domains including epidemiology, surgical techniques, graft fixation, adjuvant therapies, ocular surface outcomes, refractive outcomes, systemic associations, histopathology, and artificial intelligence. Methodological quality was assessed using AMSTAR 2. Findings were synthesized narratively. RESULTS: A total of 380 records were identified, with 155 duplicates removed. After screening and full-text assessment, 26 reviews were included. The strongest evidence supported ultraviolet exposure as the main risk factor, conjunctival autograft as the preferred surgical approach, and fibrin glue as the most effective fixation method for reducing recurrence and operative time. Additional evidence supported the use of selected adjuvants, particularly mitomycin C. It demonstrated improvements in ocular surface and refractive outcomes following surgery, although these effects varied by technique, duration of follow-up, and disease severity. Systemic biomarkers, histopathological findings, and artificial intelligence were associated with more limited or emerging evidence. CONCLUSIONS: Pterygium research contains a well-defined evidence-based core centered on environmental risk, autograft-based reconstruction, and graft fixation. However, several clinically relevant areas remain under-synthesized, including complications, technical refinements, and long-term functional outcomes. This umbrella review provides a structured overview of current evidence and highlights priorities for future research.