Methoxsalen-induced macular toxicity

Abstract

Psoralen compounds such as methoxsalen are photosensitizer agents used in conjunction with ultraviolet A (UVA) radiation exposure as photochemotherapy (Psoralens and ultraviolet-A therapy [PUVA therapy]) for certain epidermal skin disorders such as psoriasis and vitiligo. Methoxsalen has been shown to be associated with premature cataract formation by forming adducts with lens proteins following oral administration and subsequent UVA exposure. Hence, the use of UV-filtering glasses is recommended during PUVA therapy sessions. Ocular tissues can be exposed to its photosensitizing effect with subsequent UV radiation exposure through sunlight if the patient was to be without protective eye glasses, potentially causing macular toxicity. Till date, there have been no reports in the literature of any posterior segment ocular toxicity arising from methoxsalen use. Here, we describe a case of a bilateral macular toxicity in a middle-aged male treated with methoxsalen for vitiligo.

Ocular manifestations of skin diseases with pathological keratinization abnormalities

“…Some patients may require laser therapy or ophthalmological operations like vitrectomy, corneal transplantations, cataract or oculoplastic surgery to save vision functions. One should be aware that the prescribed therapy may also affect the eye and its functions, causing complications, so regular ophthalmological control visits are needed for physicians and patients [ 20 , 26 – 28 ].…”

“…Clinicians should be aware of possible ophthalmic complications, which can occur with the treatment of psoriasis and take them into account, including keratitis, conjunctival injection, dry eye syndrome, posterior subcapsular cataract, serous retinal detachment, UV keratitis, cataract or macular toxicity after methoxypsoralen use in PUVA treatment without appropriate eye protection [ 20 , 26 , 27 ].…”