Lenticular psoralen photoproducts and cataracts of a PUVA-treated psoriatic patient

Ocular psoriasis

“…In all such cases the ages of patients were younger than 55 years except in the study of Lerman et al 90 where patient ages were not reported. 81,84,91,92 This finding supports the hypothesis that in younger lenses, the gamma-crystalline fraction of the lens proteins are more sensitive to UV light than in older lenses. 93 …”

“…They bind to proteins in the lens and may potentially increase cataract formation. 80,83,84 Therefore, patients are counseled to protect their eyes during therapy and to wear UV-blocking sunglasses for 12 to 24 hours after treatment. 83 Increased risk for anterior cataract formation was seen in early guinea pig studies; however, these studies used high doses of UV radiation and subsequent studies using psoralen doses comparable with standard therapeutic human doses failed to show similar risk.…”

Psoralen plus ultraviolet A does not increase the risk of cataracts: A 25-year prospective study

“…[12][13][14][15][16][17] However, there are some isolated reports that, even if they cannot prove a relation between PUVA exposure and an increase risk of eye damage, they are a source of concern regarding PUVA treatment safety. 3,7,11 These studies examined a small number of patients and often for a limited period, so their power to detect any potential risk for cataract formation is low.…”

“…1 After oral administration, psoralens are found in human and animal lenses. [2][3][4] UVA is absorbed in the lens and there is evidence that in the presence of this radiation, psoralens can bind to the pyrimidine bases of DNA and RNA, which results in a photo-oxidation reaction and causes interchain cross-linkages between the nucleic acids. Because the lens never sheds its cells, protein-bound 8-methoxypsoralen might be retained and accumulate in the lens after repeated PUVA therapy, increasing the risk of irreversible opacification.…”

“…Some case reports suggest there might be a relation between PUVA exposure and visual impairment, 3,7,11 whereas other surveys support that it is unlikely that PUVA causes eye abnormalities. [12][13][14][15][16][17] Different definitions of cataract have been used in various studies and, with exception of our prior publications, most of them had a limited period of follow-up and studied small numbers of patients.…”