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ORIGINAL CONTRIBUTIONS
Year : 1991  |  Volume : 57  |  Issue : 3  |  Page : 135-137

A study of ocular findings in vitiligo patients treated with PUVASOL




Correspondence Address:
R Doria


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Source of Support: None, Conflict of Interest: None


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  Abstract 

Ocular changes were studied in sixty patients treated with PUVASOL at six months interval. Trioxelen, psoralen and 8 MOP in 3 groups of twenty patients each were given for eighteen months. Photo adduct formation of cornea and lens were noticed after six months of therapy. Reversible visual acuity changes were seen at each visit. Fundus showed dull macular degeneration with psorelens and 8 MOP in patients above thirty years of age.


Keywords: PUVA, PUVASOL, Anterior segment, fundus, photo adducts.


How to cite this article:
Doria R, Bhargava R. A study of ocular findings in vitiligo patients treated with PUVASOL. Indian J Dermatol Venereol Leprol 1991;57:135-7

How to cite this URL:
Doria R, Bhargava R. A study of ocular findings in vitiligo patients treated with PUVASOL. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2019 Jun 17];57:135-7. Available from: http://www.ijdvl.com/text.asp?1991/57/3/135/3649


Vitiligo is a common acquired disfiguring pigmentary disease of the skin,[1] various therapeutic modalities have been tried, but PUVA or PUVASOL is the preferred treatment and this too is to be given for a very long time[2]. In earlier studies, various side effects of this therapy pertaining to skin[3], eye, blood[4],[5],[6],[7] and liver[8] have been described. In country like India, the patients on PUVASOL therapy are more exposed to sunlight due to their nature of work and this can result into more harmful effects on the eye and skin. Our climatic condition and nature of work with long term exposure of UV radiation while on psoralens can produce ocular complications. The follow­ing is a report of our observations in sixty such patients


  Materials and Methods Top


The present study was done jointly in the Departments of Skin, STD & Leprosy and Ophthalmology, S.M.S. Medical College & Hospital, Jaipur. Sixty patients were taken into this study. Age ranged upto 60 years, the maximum number of patients belonged to age group 11-20 years. Total number of patients were divided into there groups, each group consisted of 20 patients. Trioxelen, Psoralen and 8 MOP were given in 0.6 mg/kg of body weight. Patients were asked to take the drug after breakfast and 2 hours later, the vitiliginous lesions were exposed to sunlight for ten minutes. All the patients were thor­oughly examined and evaluated clinically be­fore the therapy was started. Special care was taken, to see that patients admitted to the study belonged to a group where daily exposure to the U.V. radiation was more or less similar. Jaipur is in the temperate zone geographically and is situated at Axis 26/55 North and 75/52 East. UV radiation reaching the earth at different time of the day vary because it is linked with pressure exerted by the expanding population, ecological factors, individual factors and seasonal changes. Hemogram, Urine examination, stool exami­nation and liver function tests were done prior to the therapy.

Each group of patients were followed up for 18 months once every six months. On each subsequent visits clinical improvement, cutaneous side effects and ophthalmological changes, if any, were recorded.

Ophthalmological examination included visual acuity, anterior segment examination (by Haagstreit 900 slit lamp and torch) and Fundus examination (direct ophthalmoscopy by Heinemicroflex ophthalmoscope) were done on each visit.


  Results Top


Ocular changes were seen with all the three drugs. Reversible visual acuity changes were noticed on each visit in each group of patients.

Corneal changes in form of discrete dusty golden yellow deposits in epithelium, stroma and endothelium were seen at each follow up visit, the finding were more conspicuous after 18 months of therapy and incidence was slightly higher in psoralen group.

Similar changes were also observed in lens both in anterior subcapsular region and posterior subcapsular region. In trioxelen group, the changes were only noticeable after 18 months predominantly in 11-20 years and 31-40 years age group. In psoralen group the 1enticular changes were seen after 12 months in 21-30 years age group and in all age groups after 18 months except 1-10 years age group. In 8-MOP group none had 1enticular changes after 6 months and 12 months of the therapy, only one patient had posterior sub­capsular changes after 18 months in age group 31-40 years.

In fundus, the changes were in the form of dull macular reflex and dull macular de­generation only with psoralen and 8-MOP above 41 years and 31-40 years respectively, remarkably no fundus involvement was seen with trioxelen.


  Comments Top


Various studies in the animals and hu­mans have been done with PUVA therapy to see ocular side effects[9],[10], but the ocular changes with PUVASOL therapy have not been described in earlier studies.

In present study ocular changes were noticed with all the three drugs and no age was spared but these were less common with trioxelen. In cornea photo adducts were seen in all the three layers of cornea more commonly so after 18 months of therapy and it appears to be does related. In lens photo adducts were seen in anterior and posterior subcapsular region whereas nuclear region was not involved at all.

In our study none developed cataract. Macular degeneration and dull macular reflex were only observed in patients of more than 30 years of age with psoralen and 8-MOP, which could be due to age related process.

All these changes with PUVASOL therapy may be due to tropical climatic con­ditions and availability of UV rays from dusk to down in this part of the country.

 
  References Top

1.Awachat A K, Sharma M L, and Rao R S : Vitiligo, Ind J Dermatol,1960; 5 : 99.  Back to cited text no. 1    
2.John A, Parrish M D, Thomas B, et al, Photochemotherapy of Vitiligo. Use of orally ad­ministered psoralens and a high intensity long wave ultraviolet light system, Arch Dermatol, 1976 : 112 : 1531-1534.  Back to cited text no. 2    
3.Cox N H, Jones S K, Downey D J, et al : Cutane­ous and ocular side effects of oral photochemotherapy : results of an 8 year follow up study. Brit J Dermatol,1987; 116 : 145-152.  Back to cited text no. 3    
4.Fenton D A, Wilkinson J D : Dose related visual defects in the patients receiving PUVA therapy, Lancet,1933; 1 : 1106.  Back to cited text no. 4    
5.Pedis Leftick A, Crylin M N, Soloman L M : Cata­racts in a patient with vitiligo who received photochemotherapy, Arch Dermatol, 1979; 115 1253-1254.  Back to cited text no. 5    
6.Stern R S, Parrish J A, Fitzpatrick T B : Ocular findings in patients treated with PUVA, J. Invest Dermatol,1985; 85 : 269-273.  Back to cited text no. 6    
7.Freeman K, Warim A P, Acute myclomonocytic leukemia developing in a patient with psoriasis treated with oral 8-methoxypsoralen and long-wave ultraviolet light, Clin Exp Dermatol,1985; 10 : 144­6­  Back to cited text no. 7    
8.Freeman K, Warin A P : Deterioration of liver function during PUVA therapy, Photodermatology,1984; 1 : 147-148.  Back to cited text no. 8    
9.Lerman S : Ocular phototoxicity and psoralens plus UVR (320-400 nm) therapy : an experimental and clinical evaluation, JNCI 1982; 69 : 287 - 302  Back to cited text no. 9    
10.Parrish J A, Chylak L T, Woehler M L et al Dermatological and ocular examination in rabbits chronically photosensitized with methoxsalen, J Invest Dermatol, 79; 73 : 256-258.  Back to cited text no. 10    




 

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