As it is known, the main problem of surgical treatment of pterygium is associated with high risk of recurrence. Quite a number of surgical techniques now exist, all aimed at pterygium removal and only differing in the method of conjunctival closure following the excision. Due to relatively low recurrence rates, conjunctival or conjunctival-limbal autografts are currently the ‘gold standard’ of pterygium surgery. The frequency of recurrence is also insignificant in peripheral anterior lamellar keratoplasty, which is rarely performed due to its complexity and the need for donor cornea. However, it is considered to be the method of choice in cases of repeated recurrence as well as in patients with high pterygium activity. This article describes a clinical case of a massive recurrent pterygium (grade IV, activity level 3). The patient has had three previous surgeries (including conjunctival autotransplantation) that yielded no success. By performing large-diameter peripheral anterior lamellar keratoplasty in combination with adjuvant therapy (intraoperative mitomycin C and subconjunctival postoperative aflibercept injections), structural integrity of the cornea was finally restored without further recurrences and visual acuity was increased.