Acrylate yellow filters in operating lights protect against photosensitization tissue damage

Hinnen, P.; Rooij, Felix W.M. de; Voortman, Gardi; Tilanus, Hugo W.; Wilson, J. H. P.; Siersema, Peter D.

doi:10.1046/j.1365-2168.2000.01325.x

Cited by 10 publications

(8 citation statements)

References 17 publications

(10 reference statements)

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“…Photochemically induced membrane damage8 measured as hemolysis then served as a marker for phototoxicity. Animals or cell cultures photosensitized by endogenously produced protoporphyrin after stimulation with 5‐aminolaevulinic acid have been used for similar purposes 14. These models resemble our model but differ from clinical EPP in protoporphyrin distribution and are hampered by costs and laboriousness.…”

Section: Discussionmentioning

confidence: 99%

Protection from phototoxic injury during surgery and endoscopy in erythropoietic protoporphyria

et al. 2008

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Erythropoietic protoporphyria is an inherited condition characterized by pronounced solar photosensitivity and in a minority of patients severe liver disease that necessitates liver transplantation for survival. Phototoxic injury to abdominal organs and skin has been reported in several cases of liver transplantation surgery, including a few transplants in which protective light filters were used. This study discusses the optimal characteristics of light filters used during liver transplantation surgery. An experimental model is used to evaluate the relative protection of different filters, and the results are compared with theoretical calculations regarding the risk for phototoxic injury from light sources in health-care procedures. Whether protective measures are warranted in other illuminated procedures besides liver transplantation has been discussed often but never studied. This study elucidates the risk for phototoxic injury in endoscopy, laparoscopy, and non-liver transplant surgery. A theoretical model and epidemiological data are considered. Our findings indicate that endoscopy, laparoscopy, and surgical procedures other than liver transplantation are safe in the noncholestatic protoporphyria patient and that general recommendations for using filters in these situations are not warranted. Among the tested filters, a flexible yellow filter omitting wavelengths below 470 nm is recommended for liver transplant surgery. This filter has been readily accepted by surgeons and offers a good balance between protection and altered visual color perception. The experimental model, using hemolysis of protoporphyrin-loaded erythrocytes as a measure of phototoxicity, has substantiated theoretical findings on relative filter protection.

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Section: Discussionmentioning

confidence: 99%

Protection from phototoxic injury during surgery and endoscopy in erythropoietic protoporphyria

et al. 2008

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“…In order to overcome these problems, some authors operate in semi-dimmed operation theatres with the use of head lights [7]. Others recommend the use of special filters for the operation lights blocking out light of certain wave lengths which would activate the photosensitiser [8]. As a consequence of the filtering the surgical light appears somewhat yellow.…”

Section: Introductionmentioning

confidence: 99%

Experimental evaluation of possible side effects of intra‐operative photodynamic therapy on rabbit blood vessels and nerves

et al. 2003

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Our results have shown that mTHPC mediated intra-operative PDT used with a maximal treatment protocol (very high doses and very short drug-light intervals) has significant histological impact onto all tissue structures, but did not show any clinical symptoms in rabbits. mTHPC mediated intra-operative PDT seems to be a promising and a safe treatment option which could complement existing treatment modalities in order to improve total survival rate of tumour patients.

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“…Photodegradation of porphyrins and photosensitization tissuedamage during exposure to the operating lights was prevented by covering the tissues not in the immediate operating field with gauzes and shielding the operating lights with acrylate yellow filters (Wientjes BV, Roden, The Netherlands), which eliminate nearly all UV and blue light below a wavelength of about 520 nm (Hinnen et al, 2000a). For 48 h after the administration of ALA, patients were kept in subdued light.…”

Section: -Aminolaevulinic Acid Administrationmentioning

confidence: 99%

Porphyrin biosynthesis in human Barrett's oesophagus and adenocarcinoma after ingestion of 5-aminolaevulinic acid

et al. 2000

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Barrett's oesophagus (BE) is a pre-malignant condition in which progression from metaplasia to low-grade dysplasia and highgrade dysplasia could lead to invasive adenocarcinoma of the oesophagus (AC) (Hameeteman et al, 1989;van der Burgh et al, 1996;Drewitz et al, 1997). High-grade dysplasia is often regarded as an indication for oesophagectomy (Clark et al, 1996;Edwards et al, 1996;Cameron and Carpenter, 1997). A possible alternative, which is less mutilating and also applicable in patients with a high surgical risk, is 5-aminolaevulinic acid-induced photodynamic therapy (ALA-PDT).Two relevant clinical studies have been performed, in which patients with high-grade dysplasia or early cancer in BE received an oral dose of ALA (60 mg kg -1 ), followed by photoactivation 4-6 h later (Barr et al, 1996;Gossner et al, 1998). Both high-grade dysplasia and early cancer were eradicated allowing regeneration of squamous epithelium without scarring or stricture formation. However, the presence of islands of columnar cells remaining beneath regenerating squamous epithelium created the concern that superficial healing could mask underlying dysplasia. These results suggest that ALA-PDT needs to be improved.Haem biosynthesis, an essential process in every cell, is the basis of ALA-PDT ( Figure 1). ALA is the first intermediate, and two molecules of ALA are converted to porphobilinogen (PBG) which is metabolized to porphyrinogen intermediates by porphobilinogen deaminase (PBG-D). The last step of haem biosynthesis is the insertion of iron into PPIX by ferrochelatase (FC). Normally, haem synthesis is regulated by feedback inhibition of the enzyme ALA synthase. Exogenous ALA bypasses this feedback inhibition and the activities of PBG-D and FC and the intracellular iron pool become rate-limiting factors. As a result porphyrins, predominantly PPIX, will accumulate (Bishop and Desnick, 1982;Kennedy and Pottier, 1992). Previously, we observed an imbalance between the activities of PBG-D and FC in BE and AC (Hinnen et al, 1998). The ratio between PBG-D and FC activities, normalized for squamous epithelium, was found to be significantly higher in BE and AC. In that study, we suggested that this ratio, which we have called the PDT power index, might be a useful parameter for predicting the accumulation of PPIX in tissues after the administration of ALA.In this study, we examined the relation between the PDT power index and the intracellular concentration of PPIX in tissues of patients with BE and AC at approximately 6 h after ALA ingestion (60 mg kg -1 ) as this is the clinically most frequently used time interval. We determined the intracellular concentrations of ALA and other haem intermediates by biochemical extraction methods rather than fluorescence microscopy as used by others (Regula et al, 1995;Barr et al, 1996). In addition, plasma pharmacokinetics of ALA and porphyrins were studied and side-effects were monitored. MATERIALS AND METHODS PatientsIn total 10 patients (two women and eight men; age 44-81 years; mean 65 years) gave ...

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Acrylate yellow filters in operating lights protect against photosensitization tissue damage

Abstract: Photodamage induced by operating lights can be reduced by filtering out ultraviolet and blue light by means of acrylate yellow filters.

Cited by 10 publications

References 17 publications

Protection from phototoxic injury during surgery and endoscopy in erythropoietic protoporphyria

Protection from phototoxic injury during surgery and endoscopy in erythropoietic protoporphyria

Experimental evaluation of possible side effects of intra‐operative photodynamic therapy on rabbit blood vessels and nerves

Porphyrin biosynthesis in human Barrett's oesophagus and adenocarcinoma after ingestion of 5-aminolaevulinic acid

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