What's UP Doc?

What's UP Doc? Is a monthly column where we feature a patient question along with a response from a member of the UPA Scientific Advisory Board.

Do you have a question you would like to ask a Porphyria Expert?  Send us an email at info@porphyria.org. We’d love to hear from you!

I have EPP and am having a planned laparoscopic surgery next week. Should there be a filter on the light on the laparoscope? If so, would you be able to tell me what filter would need to be used? Can you also tell me what filters would be needed for the surgery lights in the operating room?

This question was about EPP, but the information also applies to other types of light-sensitive porphyria (CEP, VP, HCP, PCT).

The risk of having a reaction to the different types of light used during surgery depends on several factors, including:

• The severity of your EPP or other porphyria, how long does it take to have a phototoxic reaction when exposed to light?
• The concentration of red blood cell and plasma protoporphyrin
• The length of the procedure
• The intensity of the operating room or other lights used

The more severe your EPP and the longer the procedure, the higher the likelihood of a reaction. While you are unlikely to have a reaction during a short procedure or from a laparoscope, the safest approach is to take steps to minimize exposure to unsafe light (wavelengths 400-470nm). Lights to consider are:

• Operating room lights and laparoscope lights. These can be covered with filters that will block unsafe wavelengths of light. Recommended filters include:
  • Amber-81 or Protekt CLS-200-X films from Madico
  • Kapton polyimide film 200H from Dupont
• The finger pulse/oxygen device should not be left on your finger for extended periods. These types of devices shine light unto the finger where they are attached. I’d advise they be put on periodically to take measurements and then removed.

Overall, surgery can be undertaken safely with a cutaneous porphyria if steps are taken to minimize the risk of a phototoxic reaction.

Reference:

Successful Liver Transplantation for Liver Failure With Erythropoietic Protoporphyria by Covering the Operating Theater Lights With Polyimide Film: A Case Report in Transplantation Proceedings, Volume 52, Issue 2, 2020, Pages 625-629. https://doi.org/10.1016/j.transproceed.2019.12.004.

Thank you to Dr. Herbert Bonkovsky for this What's UP Doc? answer! Do you have a question for a porphyria expert? Send it to info@porphyria.org.