Management of pterygia: should thiotepa be used?

Pterygium, a common source of morbidity throughout the world, may appear to be an innocuous, easily excised lesion, yet it plagues the ophthalmologist by its high rate of recurrence, ranging from 20% to 30% after simple excision. Beta irradiation has been used by ophthalmic surgeons for many years. Another method of stemming the high percentage of pterygium recurrence is through local application of thiotepa, a radiomimetic drug that inhibits rapidly proliferating cells. The following report is a review of the literature from 1960 to 1977 on the role of thiotepa in treatment of pterygium, with emphasis on the complications of thiotepa administration. The recurrence rate after topical postoperative use of thiotepa ranges from 0 to 8%, with disturbing variance in results, depending on each investigator's definition of "recurrence", the length of follow-up, the type of pterygium, and the number of patients. The main reported complication from thiotepa's use has been depigmentation of skin around several patients' eyes, sometimes precipitated by exposure to the sun's rays.