Triethylene thiophosphoramide (thio-tepa) and pterygium

Area of Science:

• Ophthalmology
• Surgical Oncology
• Pharmacology

Background:

• Pterygium recurrence is a common complication after surgical excision.
• Proliferating vascular endothelium plays a key role in pterygium growth and recurrence.
• Radiomimetic alkylating agents, such as thio-tepa, have demonstrated inhibitory effects on endothelial proliferation.

Observation:

• A topical solution of thio-tepa (triethylene thiophosphoramide) was administered adjunctively to the bare-sclera surgical technique for pterygium excision.
• The treatment involved applying two drops of a 1:2000 thio-tepa solution every three hours while awake, starting on the second postoperative day for six weeks.
• Twenty-six eyes received this topical thio-tepa treatment postoperatively.

Findings:

• Only one recurrence was observed among the 26 eyes treated with topical thio-tepa over a follow-up period of up to three years.
• In contrast, two out of four control eyes, which underwent the same surgical procedure without topical thio-tepa, experienced pterygium recurrence.
• No adverse effects, including corneal damage, vision impairment, wound healing interference, or systemic toxicity, were noted in the treated eyes.

Implications:

• Topical thio-tepa is a safe, cost-effective, and valuable adjunct for reducing pterygium recurrence following surgical excision.
• The findings support the use of thio-tepa as a therapeutic option in ophthalmic surgery to manage conditions involving excessive vascular proliferation.
• Further research may explore optimal dosing and long-term efficacy of thio-tepa in preventing ocular surface disease recurrence.