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Zinnert HM, Gladfelter MF, Poe HP, Merrill KL, Hennessey AV, McDonald MB, Wang D, Torbert HA, Wilson AE. Positive and negative impacts of flue gas desulfurization (FGD) gypsum on water quality. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2023; 348:119307. [PMID: 37862886 DOI: 10.1016/j.jenvman.2023.119307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
Flue gas desulfurization (FGD) gypsum, a by-product of carbon-based energy sources, has typically been incorporated as a component of concrete mixes and wallboard and beneficially used as an agricultural amendment to enhance terrestrial crop production and improve the quality of runoff. These various uses for the by-product aid in reducing the amount that is ultimately landfilled. Limited studies have investigated its benefits when used directly in aquatic settings, such as ponds and lakes, to increase hardness and potentially mitigate eutrophication. A 36-day field mesocosm experiment tested a larger range of FGD gypsum concentrations (500-2000 mg/L) than those previously tested in the literature to investigate its desired and potentially undesired impacts on water quality, including the algal community. High FGD gypsum concentrations, 1000 and 2000 mg/L, were found to have more undesired impacts than the 500 mg/L treatment, including an initial spike in cyanobacteria, a decrease in total zooplankton abundance, and an increase in certain trace metals in the highest treatment. Ultimately, the 500 mg/L FGD gypsum treatment was found to have fewer undesired impacts while still resulting in significant desired effects, including those on hardness and pH, as well as moderate reductions in algal abundance. This experiment provides a better understanding of the effects of FGD gypsum when directly used in an aquatic setting, determines an optimal dose for future field experiments, and helps provide the groundwork for developing an upper threshold on FGD gypsum so as to not have the negative effects outweigh the positive.
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McDonald MB, Hammond PT. Efficient Transport Networks in a Dual Electron/Lithium-Conducting Polymeric Composite for Electrochemical Applications. ACS APPLIED MATERIALS & INTERFACES 2018; 10:15681-15690. [PMID: 29658692 DOI: 10.1021/acsami.8b01519] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this work, an all-functional polymer material composed of the electrically conductive poly(3,4-ethylenedioxythiophene):poly(4-styrenesulfonic acid) (PEDOT:PSS) and lithium-conducting poly(ethylene oxide) (PEO) was developed to form a dual conductor for three-dimensional electrodes in electrochemical applications. The composite exhibits enhanced ionic conductivity (∼10-4 S cm-1) and, counterintuitively, electronic conductivity (∼45 S cm-1) with increasing PEO proportion, optimal at a monomer ratio of 20:1 PEO:PEDOT. Microscopy reveals a unique morphology, where PSS interacts favorably with PEO, destabilizing PEDOT to associate into highly branched, interconnected networks that allow for more efficient electronic transport despite relatively low concentrations. Thermal and X-ray techniques affirm that the PSS-PEO domain suppresses crystallinity, explaining the high ionic conductivity. Electrochemical experiments in lithium cell environments indicate stability as a function of cycling and improved overpotential due to dual transport characteristics despite known issues with both individual components.
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McDonald MB, Freund MS, Hammond PT. Catalytic, Conductive Bipolar Membrane Interfaces through Layer-by-Layer Deposition for the Design of Membrane-Integrated Artificial Photosynthesis Systems. CHEMSUSCHEM 2017; 10:4599-4609. [PMID: 29024529 DOI: 10.1002/cssc.201701397] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/19/2017] [Indexed: 06/07/2023]
Abstract
In the presence of an electric field, bipolar membranes (BPMs) are capable of initiating water disassociation (WD) within the interfacial region, which can make water splitting for renewable energy in the presence of a pH gradient possible. In addition to WD catalytic efficiency, there is also the need for electronic conductivity in this region for membrane-integrated artificial photosynthesis (AP) systems. Graphene oxide (GO) was shown to catalyze WD and to be controllably reduced, which resulted in electronic conductivity. Layer-by-layer (LbL) film deposition was employed to improve GO film uniformity in the interfacial region to enhance WD catalysis and, through the addition of a conducting polymer in the process, add electronic conductivity in a hybrid film. Three different deposition methods were tested to optimize conducting polymer synthesis with the oxidant in a metastable solution and to yield the best film properties. It was found that an approach that included substrate dipping in a solution containing the expected final monomer/oxidant ratio provided the most predictable film growth and smoothest films (by UV/Vis spectroscopy and atomic force microscopy/scanning electron microscopy, respectively), whereas dipping in excess oxidant or co-spraying the oxidant and monomer produced heterogeneous films. Optimized films were found to be electronically conductive and produced a membrane ohmic drop that was acceptable for AP applications. Films were integrated into the interfacial region of BPMs and revealed superior WD efficiency (≥1.4 V at 10 mA cm-2 ) for thinner films (<10 bilayers≈100 nm) than for either the pure GO catalyst or conducting polymer individually, which indicated that there was a synergistic effect between these materials in the structure configured by the LbL method.
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McDonald MB, Bruce JP, McEleney K, Freund MS. Reduced Graphene Oxide Bipolar Membranes for Integrated Solar Water Splitting in Optimal pH. CHEMSUSCHEM 2015; 8:2645-2654. [PMID: 26204850 DOI: 10.1002/cssc.201500538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/27/2015] [Indexed: 05/24/2023]
Abstract
The integration of light absorbers and catalysts for the water splitting process requires a membrane capable of both ion and electron management and product separation to realize efficient solar fuels systems. Bipolar membranes can maintain a pH gradient for optimal reaction conditions by the dissociation of water. Such membranes that contain graphene in the interfacial layer are fabricated by the chemical reduction of a uniformly deposited graphene oxide layer to convert sp(3) catalyst regions to sp(2) conductive regions. The resulting electrical and water dissociation properties are optimized by adjusting the exposure conditions, and treatments of less than 5 min render an interface that exceeds the conductivity requirements for integrated solar water splitting and increases the overpotential by <0.3 V. Integration with photoelectrodes is examined by characterizing the electrical interface formed between graphene and Si microwires, and we found that efficient Ohmic junctions are possible.
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McDonald MB, Ardo S, Lewis NS, Freund MS. Use of bipolar membranes for maintaining steady-state pH gradients in membrane-supported, solar-driven water splitting. CHEMSUSCHEM 2014; 7:3021-7. [PMID: 25250978 DOI: 10.1002/cssc.201402288] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Indexed: 05/24/2023]
Abstract
A bipolar membrane can maintain a steady-state pH difference between the sites of oxidation and reduction in membrane-supported, solar-driven water-splitting systems without changing the overall thermodynamics required to split water. A commercially available bipolar membrane that can serve this purpose has been identified, its performance has been evaluated quantitatively, and is demonstrated to meet the requirements for this application. For effective utilization in integrated solar-driven water-splitting systems, such bipolar membranes must, however, be modified to simultaneously optimize their physical properties such as optical transparency, electronic conductivity and kinetics of water dissociation.
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McDonald MB, Freund MS. Graphene oxide as a water dissociation catalyst in the bipolar membrane interfacial layer. ACS APPLIED MATERIALS & INTERFACES 2014; 6:13790-13797. [PMID: 25046580 DOI: 10.1021/am503242v] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bipolar membranes are formed by the lamination of an anion- and cation-exchange layer. Upon a sufficient applied reverse bias, water molecules at the layer junction dissociate, generating OH(-) and H(+), which can be useful in electrodialysis and electrosynthesis applications. Graphene oxide has been introduced into bipolar membrane junctions (illustrated in the adjacent graphic) and is shown to be an efficient new water dissociation catalyst, lowering the overpotential by 75% compared to a control membrane. It was found that adjusting deposition conditions changes the nature of the graphene oxide films, leading to tunable membrane performance. Additionally, it is shown that their low overpotentials are stable, making for industrially viable, high-performance bipolar membranes.
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McDonald MB, Freund MS. Novel conducting polymer-heteropoly acid hybrid material for artificial photosynthetic membranes. ACS APPLIED MATERIALS & INTERFACES 2011; 3:1003-1008. [PMID: 21384827 DOI: 10.1021/am1010223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Artificial photosynthetic (AP) approaches to convert and store solar energy will require membranes capable of conducting both ions and electrons while remaining relatively transparent and chemically stable. A new approach is applied herein involving previously described in situ chemical polymerization of electronically conducting poly(3,4-ethylenedioxythiophene) (PEDOT) in the presence of proton conducting heteropoly acid (HPA) phosphomolybdic acid (PMA). The electrochemical behaviour of the PEDOT/PMA hybrid material was investigated and it was found that the conducting polymer (CP) is susceptible to irreversible oxidative processes at potentials where water is oxidized. This will be problematic in AP devices should the process occur in very close proximity to a conducting polymer-based membrane. It was found that PEDOT grants the system good electrical performance in terms of conductivity and stability over a large pH window; however, the presence of PMA was not found to provide sufficient proton conductivity. This was addressed in an additional study by tuning the ionic (and in turn, electronic) conductivity in creating composites with the proton-permselective polymer Nafion. It was found that a material of this nature with near-equal conductivity for optimal chemical conversion efficiency will consist of roughly three parts Nafion and one part PEDOT/PMA.
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McDonald MB, McMillan J. Predicting blood usage in cardiac surgery--the transfusion predictor product. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2005; 37:157-60. [PMID: 16117452 PMCID: PMC4682531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Blood cross-matched for patients undergoing cardiac surgery is used infrequently and represents a significant cost. We investigated the ability to predict the need for intraoperative transfusion. We hypothesized that red blood cell volume is a predictor because dilution is the primary cause for transfusion requirement intraoperatively. A total of 401 consecutive patients having cardiothoracic surgery requiring the use of cardiopulmonary bypass were retrospectively analyzed by revision of their perfusion record. This sample included 82% elective, 17% urgent, and 1% emergency procedures. The product of body surface area and preoperative hemoglobin gave us gHb/l/m2, which are the units of the Transfusion Predictor Product (TPPU). Mean patient age was 66.9 +/- 10.7 years, and 112 (28%) were women. Mean TPP was 257.2 +/- 45.5u. 52 patients (13%) received red blood cells intraoperatively. At less than TPP 211.7u, one standard deviation below the mean value, 32 patients of 69 (46%) received blood transfusion intraoperatively (p < 0.001). At a TPP greater than 211.7u, 20 patients of 322 (6%) had blood transfusion intraoperatively. Patients with a TPP > 211.7u do not require routine cross-matching of blood. Cross-matching for these patients should be individualized on the basis of predicted duration of CPB and/or other types of patient comorbidity.
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Endl MJ, Martinez CE, Klyce SD, McDonald MB, Coorpender SJ, Applegate RA, Howland HC. Effect of larger ablation zone and transition zone on corneal optical aberrations after photorefractive keratectomy. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 2001; 119:1159-64. [PMID: 11483083 DOI: 10.1001/archopht.119.8.1159] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the effects of photorefractive keratectomy on corneal optical aberrations using a 5.5-mm optical zone and a 7.0-mm transition zone. METHODS Videokeratographs of 72 eyes from 47 patients treated for low to moderate (1-9 diopters) myopia were obtained at the preoperative and 1-, 3-, 6-, 12-, and 18-month postoperative examinations. The videokeratoscopy data files were used to calculate the wavefront variance of the corneas for small (3-mm) and large (7-mm) pupils using a previously described method. RESULTS In general, all optical aberrations decreased postoperatively for 3-mm pupils and increased for 7-mm pupils compared with preoperative values. For 3-mm pupils, the 2 common optical aberrations (comalike [S(3)] and spherical-like [S(4)]) decreased postoperatively and never returned to preoperative values. For 7-mm pupils, however, comalike aberrations increased slightly and spherical-like aberrations increased by nearly an order of magnitude during the postoperative period. Similarly, for 3-mm pupils, the higher order S(5) and S(6) aberrations decreased throughout the postoperative period, with S(6) values showing an approximately 23-fold reduction at 12 and 18 months. For 7-mm pupils, S(5) and S(6) aberrations increased slightly, more so for S(5) (approximately 3-fold) than for S(6). Total wavefront aberrations decreased an average of 2.3 times postoperatively for 3-mm pupils, and increased significantly (P<.05) at all postoperative examinations for 7-mm pupils. Opening the pupil from 3 mm to 7 mm before surgery produced a 14-fold increase in total aberrations, whereas this same change produced an average 113-fold increase after photorefractive keratectomy. CONCLUSIONS Corneal optical aberrations after photorefractive keratectomy with a larger ablation zone and a transition zone are less pronounced and more physiologic than those associated with first-generation (5-mm) ablations with no transition zone. CLINICAL RELEVANCE Evaluating the postoperative corneal aberration structure will help us devise ways to minimize the wavefront aberrations of the eye through the creation of an ideal corneal first surface, thereby improving visual results for patients undergoing excimer laser ablations for refractive correction.
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McDonald MB, Carr JD, Frantz JM, Kozarsky AM, Maguen E, Nesburn AB, Rabinowitz YS, Salz JJ, Stulting RD, Thompson KP, Waring GO. Laser in situ keratomileusis for myopia up to -11 diopters with up to -5 diopters of astigmatism with the summit autonomous LADARVision excimer laser system. Ophthalmology 2001; 108:309-16. [PMID: 11158804 DOI: 10.1016/s0161-6420(00)00528-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To assess the safety and effectiveness of the Summit Autonomous LADARVision active tracking narrow beam excimer laser system for laser in situ keratomileusis (LASIK) correction of myopia and astigmatism. DESIGN A multicenter, prospective noncomparative case series. PARTICIPANTS This cohort consisted of 177 eyes corrected for spherical myopia up to -11 diopters (D) and 170 eyes corrected for myopia up to -11 D spherical equivalent with astigmatism up to -5 D. INTERVENTION Treatments were performed at four sites in the United States using a 6-mm optic zone for spherical myopes and a 5.5-mm optic zone with a 1-mm blend for astigmats. MAIN OUTCOME MEASURES Visual acuity, subjective refraction, vector analysis, subject satisfaction, intraocular pressure, complications, and adverse reactions. RESULTS Six-month follow-up was available on 157 spherical eyes and 113 astigmatic eyes. For spherical myopes, uncorrected visual acuity (UCVA) was 20/20 or better in 60.5%, 20/25 or better in 80.3%, and 20/40 or better in 93.9%. The mean spherical equivalent was -0.29 +/- 0.45 D with 75.2% +/- 0.50 D and 94.9% +/- 1.00 D of intended. A loss of two lines of best spectacle-corrected visual acuity (BSCVA) occurred in 0.6%, and no eyes lost greater than two lines of BSCVA. For astigmatic myopes, UCVA was 20/20 or better in 52.0%, 20/25 or better in 74.5%, and 20/40 or better in 94.1%. The mean spherical equivalent was -0.23 +/- 0.49 D with 75.2% +/- 0.50 D and 95.6% +/- 1.00 D of intended. A loss of two lines of BSCVA occurred in 0.9%, and no eyes lost greater than two lines of BSCVA. Vector analysis showed that 99% of the intended cylinder was corrected on average with a mean angle of error of 4.2 degrees. Refractive stability was achieved between 1 and 3 months in 97.5% of spherical eyes and 99.4% of astigmatic eyes and confirmed between 3 and 6 months in 100% of both spherical and astigmatic eyes. CONCLUSIONS Eyes treated for myopia up to -11 D of spherical equivalent with or without astigmatism up to -5 D show early refractive stability, good UCVA outcomes, no significant loss of BSCVA, accurate correction of astigmatism, and slight undercorrection without a change from the photorefractive keratectomy algorithm and with a single treatment.
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Mutyala S, McDonald MB, Scheinblum KA, Ostrick MD, Brint SF, Thompson H. Contrast sensitivity evaluation after laser in situ keratomileusis. Ophthalmology 2000; 107:1864-7. [PMID: 11013188 DOI: 10.1016/s0161-6420(00)00355-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine the effects of laser in situ keratomileusis (LASIK) on best-corrected visual acuity (BCVA) and contrast sensitivity. DESIGN Prospective, observational case series. PARTICIPANTS One hundred twelve eyes, in 65 patients with myopia and myopia with astigmatism, who underwent LASIK. TESTING AND MAIN OUTCOME MEASURES: Best-corrected visual acuity using the Snellen visual acuity chart and contrast sensitivity using the CSV 1000 (Vector Vision, Dayton OH) was tested before surgery and 1 week, 1 month, and 3 months after surgery in patients who underwent LASIK. RESULTS Contrast sensitivity was depressed for patient eyes with spherical equivalence (SE) between -1.25 diopters (D) and -13.75 D, at 12 cycles/degree for at least 3 months and at 18 cycles/degree for 1 week after LASIK. For patient eyes with SE between -1.25 D and -6.00 D, contrast sensitivity was depressed only at 12 cycles/degree for at least 3 months after LASIK. For patient eyes with SE between -6.00 D and -13.75 D, contrast sensitivity was depressed at 6, 12, and 18 cycles/degree 1 week after LASIK but returned toward preoperative levels by 1 month after surgery. Despite the slight decreases in contrast sensitivity, all scores were still within the range of normal values except for 12 cycles/degree for 3 months and 18 cycles/degree at 1 week after surgery in the high myopia group. Although highly myopic patients, compared with patients with low myopia, had slightly less BCVA before surgery, both groups maintained their preoperative BCVA at all postoperative visits. CONCLUSIONS Based on this study, we conclude that LASIK has little effect on BCVA and contrast sensitivity for up to 3 months after surgery.
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Madan M, Kereiakes DJ, Hermiller JB, Rund MM, Tudor G, Anderson L, McDonald MB, Berkowitz SD, Sketch MH, Phillips HR, Tcheng JE. Efficacy of abciximab readministration in coronary intervention. Am J Cardiol 2000; 85:435-40. [PMID: 10728946 DOI: 10.1016/s0002-9149(99)00768-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abciximab, an Fab monoclonal antibody fragment that blocks the platelet glycoprotein IIb/IIIa receptor, is increasingly used as an adjunct to coronary intervention. Little is known, however, about the efficacy and safety of readministration of abciximab. This study examined and characterized outcomes of patients receiving abciximab for a second time. From April 1995 to June 1997, 164 consecutive patients were readministered abciximab at our 3 institutions. We retrospectively examined and analyzed in-hospital outcomes in this cohort. The median time to readministration was 95 days. The angiographic success rate of percutaneous intervention was 99.5%. Rates and 95% confidence intervals of in-hospital events were death 2% (0.7% to 6.1%), myocardial infarction 3% (1% to 7%), coronary bypass surgery 0% (0% to 2.2%), and intracranial hemorrhage 2% (0.4% to 5.3%). Severe thrombocytopenia was observed in 4% of patients (1.4% to 7.8%) after readministration. Allergic or anaphylactic reactions were not observed. Major bleeding was associated with excessive concomitant antithrombotic therapy. Patients undergoing readministration of abciximab within 2 weeks of first administration experienced a higher incidence of severe thrombocytopenia (12% vs. 2%, p = 0.046). Thus, abciximab remains clinically efficacious when readministered as an adjunct to percutaneous coronary intervention. However, concomitant heparin administration must be carefully monitored and warfarin therapy should be avoided. Vigilant surveillance for thrombocytopenia should be employed. Reduced dosing may be necessary when abciximab is readministered within days of the initial administration.
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McDonald MB, Brint SF, Caplan DI, Bourque LB, Shoaf K. Comparison of ketorolac tromethamine, diclofenac sodium, and moist drops for ocular pain after radial keratotomy. J Cataract Refract Surg 1999; 25:1097-108. [PMID: 10445196 DOI: 10.1016/s0886-3350(99)00116-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the 2 most popular commercially available topical nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of ocular pain following radial keratotomy (RK). SETTING Multicenter clinical trial. METHODS Ninety-seven RK patients were randomly assigned to 1 of 3 treatment groups: ketorolac tromethamine, diclofenac sodium, and moist drops as a control. The patients used 1 drop of the masked medication and 1 drop of ofloxacin 3 times a day for 3 days prior to surgery. They received 1 drop of the masked medication 1 hour before surgery, immediately after surgery, and 4 times a day thereafter. Patients were given a written questionnaire preoperatively and were also instructed to call a central computerized telephone system to answer prerecorded questions about ocular comfort. The calls were placed 30 minutes and 1, 2, 3, 4, 5, 6, 24, and 48 hours after surgery. RESULTS Two hundred ten statistical values were calculated to compare symptoms in the unoperated eye at baseline with symptoms in the operated eyes at each of 9 postoperative time points. Only 7 of the 210 values (3.3%) were significantly different among patient groups (operated versus unoperated eyes) by psychometric testing. CONCLUSIONS Both ketorolac tromethamine and diclofenac sodium were more effective in reducing post-RK discomfort than the control (moist artificial tears). Given the large number of tests and the small number that tested as significant, the significant differences (7 of 210 measurements) observed among the 3 treatment groups probably occurred by chance, although the improved foreign-body sensation, functionality, and compliance scores in the ketorolac group during the first 4 hours might be clinically important.
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McDonald MB, Deitz MR, Frantz JM, Kraff MC, Krueger RR, Salz JJ, Kraff CR, Maguen E, Matta CS, Nesburn AB, Piebenga LW. Photorefractive keratectomy for low-to-moderate myopia and astigmatism with a small-beam, tracker-directed excimer laser. Ophthalmology 1999; 106:1481-8; discussion 1488-9. [PMID: 10442891 DOI: 10.1016/s0161-6420(99)90440-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To assess the safety and effectiveness of the Autonomous Technologies Corporation LADARVision excimer laser system for photorefractive keratectomy correction of myopia and astigmatism. DESIGN A multicenter, prospective, noncomparative case series. PARTICIPANTS The cohort consisted of 467 eyes corrected for spherical myopia and 211 eyes corrected for myopia with astigmatism. INTERVENTION Treatments were performed at six sites in the United States using a 6-mm ablation zone for spherical myopes and a 5.5-mm zone with a 1.0-mm blend for astigmats. MAIN OUTCOME MEASURES Visual acuity, subjective refraction, corneal haze, intraocular pressure, complications, adverse reactions, patient satisfaction, and corneal endothelial changes. RESULTS Twelve-month follow-up was available on 414 spherical eyes and 175 astigmatic eyes. The results for spherical eyes with correction between -1 and -5.99 diopters (D) were: uncorrected visual acuity (UCVA) of 20/40 or better achieved by 98.1%, 20/20 or better by 72%, 1.8% lost 2 lines and 0.3% lost greater than 2 lines of best spectacle-corrected visual acuity (BSCVA); 76.4% were within 0.50 D of the target correction and 94.4% were within 1.00 D. The results for myopia with astigmatism with spherical equivalent correction between -1 and -5.99 D were: UCVA of 20/40 or better in 97.4%, 20/20 or better in 61.7%, 2.5% lost 2 lines and no eyes lost greater than 2 lines BSCVA; 73.9% were within 0.50 D of the target correction and 95% were within 1.00 D. For spherical myopes combined with myopic astigmats corrected for 6 to 10 D, results were: UCVA of 20/40 or better in 93.4%, 20/20 or better in 61.2%, 2.3% lost 2 lines and no eyes lost greater than 2 lines of BSCVA; 67.2% were within 0.50 D of the desired correction and 87.8% were within 1.00 D. Refractive stability was achieved between 3 and 6 months for the spherical and astigmatic groups. No eyes had corneal haze graded as moderate or greater, and there was no significant decrease in endothelial cell density. CONCLUSIONS Patients treated for 1 to 10 D of spherical equivalent myopia, with or without astigmatism, showed early refractive stability, excellent UCVA, no significant loss of BSCVA, no loss of endothelial cell density, and very low levels of corneal haze to 12 months after surgery.
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Kemp JR, Martinez CE, Klyce SD, Coorpender SJ, McDonald MB, Lucci L, Lynn MJ, Waring GO. Diurnal fluctuations in corneal topography 10 years after radial keratotomy in the Prospective Evaluation of Radial Keratotomy Study. J Cataract Refract Surg 1999; 25:904-10. [PMID: 10404364 DOI: 10.1016/s0886-3350(99)00090-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To correlate clinically observed fluctuations in manifest refraction, visual acuity, keratometry, and intraocular pressure (IOP) with changes in the anterior corneal surface as measured by videokeratography in patients 10 years after radial keratotomy (RK). SETTING Four clinical centers in the United States that participated in the Prospective Evaluation of Radial Keratotomy (PERK) study. METHODS Thirty-two eyes of 20 PERK patients who noted diurnal fluctuations in vision had clinical examination and videokeratography (TMS-1, Computed Anatomy Inc.) in the morning and evening of the same day a mean of 10.3 years (range 7.8 to 11.7 years) after RK. The videokeratographs were analyzed in terms of various indexes generated by custom-designed software. Morning-to-evening changes in the means of the various clinical and videokeratographic values were assessed using pairwise methods. RESULTS The mean increase in myopia was 0.36 diopters (D) +/- 0.58 (SD) from morning to evening (P < .01). Analysis of the videokeratographs showed a corresponding increase in average corneal power (ACP), reflecting a steepening of 0.52 +/- 0.45 D (P < .001). The change in ACP was correlated with a change in the manifest spherical equivalent refraction (R = 0.39, P = .03) and a change in best spectacle-corrected visual acuity (R = 0.38, P = .03) over the same period. Similarly, simulated keratometry (SimK) readings correlated with the change in the manifest spherical equivalent refraction (R = 0.38, P = .03 for SimK1; R = 0.37, P = .35 for SimK2; R = 0.4, P = .02 for average SimK), although the standard clinical keratometric data did not (P = .26 for K1, P = .11 for K2, and P = .09 for the mean K). The elevation depression magnitude, a measure of the low-frequency irregularities of the cornea, showed a decrease of 0.32 +/- 1.59, which also correlated with the change in the manifest spherical equivalent refraction (R = 0.37, P = .04). Intraocular pressure tended to decrease from morning to evening (mean change of -0.97 +/- 3.29 mm Hg), but the difference was not significant. Variations in IOP in individual patients, however, were correlated with changes in the manifest spherical equivalent refraction (R = 0.37, P = .04). CONCLUSIONS Diurnal fluctuations in corneal topographic indexes can be used to evaluate the diurnal fluctuations in refraction and visual acuity after RK. The study findings provide statistical support for the idea that IOP contributes to the diurnal fluctuation in visual acuity after RK.
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Coorpender SJ, Klyce SD, McDonald MB, Doubrava MW, Kim CK, Tan AL, Srivannaboon S. Corneal topography of small-beam tracking excimer laser photorefractive keratectomy. J Cataract Refract Surg 1999; 25:674-84. [PMID: 10330644 DOI: 10.1016/s0886-3350(99)00015-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the topographic characteristic of photorefractive keratectomy (PRK) for low myopia performed with a small-beam (0.9 mm) tracking excimer laser. SETTING Department of Ophthalmology, LSU Eye Center, Louisiana State University Medical Center School of Medicine in New Orleans, and the Refractive Surgery Center of the South at the Eye, Ear, Nose, & Throat Hospital, New Orleans, Louisiana, USA. METHODS Sixty-seven eyes of 47 patients had PRK with a small-beam tracking laser. Of these, 49 eyes had data permitting evaluation of ablation centration; usable data for topographic analysis were available for 59 eyes preoperatively, 54 eyes at 1 month, 42 eyes at 3 months, and 25 eyes at 6 months, permitting measurement of various topographic parameters, including the cylinder (CYL), average corneal power (ACP), surface regularity index (SRI), surface asymmetry index (SAI), corneal eccentricity index (CEI), and coefficient of variation of corneal power (CVP). RESULTS Preoperatively, all eyes were topographically normal. Postoperatively, no eye exhibited a "central island" by even the least-restrictive definition, and all eyes had best spectacle-corrected visual acuities (BSCVAs) of 20/20 or better at all follow-ups. Mean decentration of the ablations from the pupil centers was 0.42 mm +/- 0.28 (SD) (n = 49). There was no correlation between measured decentration and BSCVA (P = .46). The central cornea was flattened (decreased ACP; P < .001) and made oblate (decreased CEI; P < .001) as expected. There was no increase in SRI or SAI (irregular astigmatism) at 6 months compared with preoperative values (P = .91); however, CYL and CVP (varifocality) increased slightly (P = .04 and .02, respectively). CONCLUSION The absence of significant regular or irregular astigmatism 6 months after PRK with the small-beam laser is an improvement over published results achieved with wide-beam lasers and is consistent with the excellent visual acuity results in this cohort.
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Pallikaris IG, Koufala KI, Siganos DS, Papadaki TG, Katsanevaki VJ, Tourtsan V, McDonald MB. Photorefractive keratectomy with a small spot laser and tracker. J Refract Surg 1999; 15:137-44. [PMID: 10202708 DOI: 10.3928/1081-597x-19990301-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND The Autonomous Technologies LADARVision excimer laser system utilizes an eye tracking mechanism and a small spot for photorefractive keratectomy. METHODS One hundred and two eyes of 102 patients were treated for -1.50 to -6.25 D of spherical myopia at the spectacle plane using a 6-mm diameter ablation zone. One year follow-up was available for 93 eyes (91%). RESULTS Uncorrected visual acuity for eyes treated for distance vision was 20/40 or better in 99% (n = 90), and 20/20 or better in 70% (n = 64) of eyes at 12 months. Spectacle-corrected visual acuity was 20/25 or better in all 92 eyes reported; no eye lost more than 2 lines of spectacle-corrected visual acuity, and only 1 eye (1.0%) experienced a loss of 2 lines (20/12.5 to 20/20) at 1 year. The refractive result was within +/- 0.50 D of the desired correction in 75% (n = 70), and within +/- 1.00 D in 93% (n = 86) of eyes at 12 months. Refractive stability was achieved between 3 and 6 months. Corneal haze was graded as trace or less in 100% of the 93 eyes. No significant reductions were noted in contrast sensitivity or endothelial cell density. CONCLUSIONS Patients treated with the Autonomous Technologies LADARVision excimer laser system for -1.50 to -6.25 D of spherical myopia with 1 year follow-up had uncorrected visual acuity of 20/20 or better in 70%, no significant loss of spectacle-corrected visual acuity, no reduction of endothelial cell density or contrast sensitivity, and low levels of corneal haze.
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McDonald MB, Wyse TB, Borodkin MJ, Ocmand A, Shoelson B, Thompson H. Comparison of the effectiveness of 4 anti-inflammatory drops in relieving photophobia after pupil dilation. J Cataract Refract Surg 1999; 25:405-10. [PMID: 10079447 DOI: 10.1016/s0886-3350(99)80090-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the relative effectiveness of diclofenac, flurbiprofen, ketorolac, and prednisolone acetate in relieving photophobia after pupil dilation for fundus examination. SETTING Eye, Ear, Nose, and Throat Hospital, New Orleans, Louisiana, USA. METHODS This prospective, blind, placebo-controlled study comprised 105 patients randomly assigned to 1 of 10 treatment groups. Five minutes after instillation of dilating drops, each patient received drops of different test medications in the right and left eyes. Light sensitivity and pupil measurement tests were performed over 2 hours after the pharmacological mydriasis. After photostimulation, patients were asked to rate their photosensitivity on numerical and analog scales and to indicate a filter value required to alleviate right-induced discomfort. Test results were analyzed to detect differences among the pain levels associated with each treatment. RESULTS There were no significant differences between the placebo and any active treatment drug at any time during the study. CONCLUSION These findings suggest that mediators other than prostaglandins may have a role in photosensitivity or that increased postmydriatic photosensitivity is a result of higher light levels entering the eye through the dilated pupil.
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Endl MJ, Martínez CE, Klyce SD, McDonald MB, Coorpender SJ, Applegate RA, Howland HC. Irregular astigmatism after photorefractive keratectomy. J Refract Surg 1999; 15:S249-51. [PMID: 10202735 DOI: 10.3928/1081-597x-19990302-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Oshika T, Klyce SD, Smolek MK, McDonald MB. Corneal hydration and central islands after excimer laser photorefractive keratectomy. J Cataract Refract Surg 1998; 24:1575-80. [PMID: 9850893 DOI: 10.1016/s0886-3350(98)80345-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine whether uneven corneal surface hydration during excimer laser photorefractive keratectomy (PRK) is related to postoperative occurrence of central islands. SETTING LSU Eye Center, New Orleans, Louisiana, USA. METHODS A retrospective study reviewed intraoperative videotapes and postoperative videokeratography of 49 eyes of 49 patients who had excimer laser PRK for myopia. The uniformity of corneal hydration within the photoablation zone, particularly the frosty appearance of the ablated zone, was characterized. The presence or absence of a topographic central island (steepening of at least 3.0 diopters and 1.5 mm in diameter) was determined from the 1 month postoperative videokeratographs. RESULTS Twelve eyes (24.5%) developed central islands postoperatively. A statistically significant association was observed between the uneven surface hydration (central accumulation of fluid) within the ablation zone intraoperatively and the formation of central islands postoperatively (P < .001, Kruskal-Wallis test; Kendall tau rank correlation = 0.534; P < .001). CONCLUSION Nonuniform fluid distribution during photoablation was a risk factor for central island formation after PRK. Intraoperatively, the presence of excess fluid in the central cornea appeared as a shiny area. This mirror-like surface layer may reduce the rate of central ablation by reflecting and absorbing a significant amount of the incident excimer laser light.
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Mustonen RK, McDonald MB, Srivannaboon S, Tan AL, Doubrava MW, Kim CK. In vivo confocal microscopy of Fuchs' endothelial dystrophy. Cornea 1998; 17:493-503. [PMID: 9756443 DOI: 10.1097/00003226-199809000-00006] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study is to analyze in vivo confocal microscopic findings of corneas with Fuchs' endothelial dystrophy. METHODS Central corneas of 17 eyes of 11 patients aged 41-86 years were examined using in vivo scanning slit confocal microscopy after being diagnosed with Fuchs' endothelial dystrophy. The cellular structure of the corneas was analyzed morphologically and quantitatively and compared to control results from 22 healthy corneas. RESULTS Bullae were detected in the basal epithelial layer of one eye. Eight of 17 eyes (47%) exhibited an abnormal Bowman's layer: diffuse bright reflection and absence of nerves. Eleven eyes (65%) exhibited abnormal anterior stroma: lacunae and diffuse increased light reflection due to edema. In 12 eyes (71%), lacunae or dark bands 5-20 microm wide against increased background reflection were noted in the posterior stroma. Descemet's membrane was thickened in all eyes. Dark bands were detected in six eyes (35%). Guttae (137-1,231/mm2) 20-40 microm in diameter were found in every endothelial cell layer. The mean endothelial cell count was 1,202 +/- 850 (cells/mm2 +/- SD; range, 0-2,735). There was a positive correlation between endothelial cell counts obtained by specular microscopy and those obtained by confocal microscopy (r = 0.95). CONCLUSION In vivo confocal microscopic findings of Fuchs' endothelial dystrophy are described for the first time in a series of cases. Pathological changes in Fuchs' dystrophy were detected in all corneal layers, more frequently in the posterior layers. Endothelial cell counts obtained with confocal microscopy were statistically similar to those obtained with standard specular microscopy.
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Mustonen RK, McDonald MB, Srivannaboon S, Tan AL, Doubrava MW, Kim CK. Normal human corneal cell populations evaluated by in vivo scanning slit confocal microscopy. Cornea 1998; 17:485-92. [PMID: 9756442 DOI: 10.1097/00003226-199809000-00005] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze cellular populations in healthy human corneas. METHODS The study group consisted of 58 eyes of 45 patients with normal corneas. The age distribution was 45 +/- 17 years (mean +/- SD; range, 20-84). Scanning slit confocal microscopy of the central corneas was performed. The images were analyzed visually for cell morphology, and the densities and areas of cells were measured. RESULTS No statistically significant differences were measured in cell densities or cell areas of any corneal layer between female and male patients (p = 0.22-0.50) nor between right and left eyes (p = 0.16-0.45). The area of superficial epithelial cells was 913 +/- 326 microm2 (mean +/- SD; range, 518-2,112), and the superficial epithelial cell density was 1,213 +/- 370 cells/mm2 (mean +/- SD; range, 473-1,929). The area of basal epithelial cells was 177 +/- 19 microm2 (mean +/- SD; range, 138-242), and the basal epithelial cell density was 5,699 +/- 604 cells/mm2 (mean +/- SD; range, 4,135-7,267). The average apparent keratocyte density was 1,058 +/- 217 cells/mm2 (mean +/- SD; range, 604-1,599) in the anterior stroma, and 771 +/- 135 cells/mm2 (mean +/- SD; range, 493-1,145) in the posterior stroma. The difference in apparent keratocyte densities between the anterior and posterior stroma was statistically significant (p < 0.001). The average endothelial cell area was 334 +/- 51 microm2 (range, 273-553), and the cell density was 3,055 +/- 386 cells/mm2 (mean +/- SD; range, 1,809-3,668). The endothelial cell density had a negative, statistically significant correlation with age (r = -0.68, p < 0.001). The densities of the other corneal cell layers did not have a statistically significant correlation with age. CONCLUSION In vivo scanning slit confocal microscopy is a useful tool for studying corneal cell populations. Central corneal cell densities were found to decrease significantly with age only in the endothelium. For the first time in human corneas using in vivo confocal microscopy, this study statistically confirms a higher apparent number of keratocytes in the anterior stroma than in the posterior stroma.
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Smolek MK, Oshika T, Klyce SD, Maeda N, Haight DH, McDonald MB. Topographic assessment of irregular astigmatism after photorefractive keratectomy. J Cataract Refract Surg 1998; 24:1079-86. [PMID: 9719967 DOI: 10.1016/s0886-3350(98)80101-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To correlate new quantitative topographic indexes of corneal irregular astigmatism to best spectacle-corrected visual acuity (BSCVA) following excimer laser photorefractive keratectomy (PRK). SETTING Department of Ophthalmology, LSU Eye Center, and Refractive Surgery Center of the South, Ear, Nose & Throat Hospital, New Orleans, Louisiana; Manhattan Eye, Ear and Throat Hospital, New York, New York, USA. METHODS Videokeratography data (TMS-1) were obtained preoperatively and 1, 3, 6, 12, 18, and 24 months postoperatively from 100 eyes having PRK for low to mild myopia. Algorithms measured fine local irregularity with the surface regularity index (SRIp), varifocality with the coefficient of variation of corneal power (CVPp), and central islands with the elevation/depression magnitude (EDM). RESULTS The SRIp and CVPp increased after surgery and remained significantly higher than the preoperative levels throughout the 24 month follow-up (P < .05). The increase in EDM was significant from 1 to 6 months (P < .05) but not thereafter. Multiple regression analysis revealed that variables having a statistically significant relationship with postoperative BSCVA were CVPp and EDM at 1 month, CVPp at 3 months, and CVPp, haze, and age at 6 months. No statistically significant correlation between any measures of irregular astigmatism and BSCVA was found after 1 year of follow-up. CONCLUSION The quantitative measures used in this study are sensitive methods by which irregular astigmatism after keratorefractive procedures can be classified, evaluated, and compared.
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Martínez CE, Applegate RA, Klyce SD, McDonald MB, Medina JP, Howland HC. Effect of pupillary dilation on corneal optical aberrations after photorefractive keratectomy. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 1998; 116:1053-62. [PMID: 9715686 DOI: 10.1001/archopht.116.8.1053] [Citation(s) in RCA: 196] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Complaints of glare, halos, and disturbances of night vision after photorefractive keratectomy (PRK) probably result from changes in the corneal aberration structure induced by the laser ablation procedure. The purpose of this article is to characterize changes in the corneal aberration structure after PRK and to demonstrate the effect of pupil dilation on these changes. METHODS Videokeratographs obtained preoperatively (n = 112) and at 1 (n = 94), 3 (n = 103), 6 (n = 91), 12 (n = 60), 18 (n = 53), and 24 (n = 44) months postoperatively from 112 eyes of 89 patients who had undergone PRK for myopia were analyzed. The data were used to calculate the wavefront variance of the cornea for both small (3-mm) and large (7-mm) pupils. RESULTS For both the 3- and 7-mm pupil, coma-like aberrations increased significantly from preoperative values to 1-month postoperative values (P < .05 and P < .001, respectively); for 7-mm pupils, the postoperative values never returned to preoperative values (P < .001, 24 months). For the 3-mm pupil, spherical-like aberrations decreased significantly 1 month after surgery (P < .001), and never returned to preoperative values. For the 7-mm pupil, spherical-like aberrations increased significantly 1 month after surgery (P < .001) and did not return to preoperative values. Opening the pupil from 3 to 7 mm increased spherical-like aberrations only 7-fold before PRK. After PRK, however, pupillary dilation caused a 300-fold increase in this type of aberration. For both pupil sizes at all times after PRK, the magnitude of the surgically induced aberration correlated with the amount of the attempted correction (P < .001, r2 = 0.6 at 1 month for a 7-mm pupil). CONCLUSIONS Photorefractive keratectomy increases the wavefront variance of the cornea; PRK changes the relative contribution of coma-like and spherical-like aberrations; after PRK, the diameter of the entrance pupil greatly affects the amount and character of the aberrations; and the magnitude of the aberration increases with the attempted correction. CLINICAL RELEVANCE Quantitative characterization of irregular astigmatism with the measurement of aberration structures following corneal surgery and the correlation of these data with visual performance in clinical trials provide the basis for understanding patient complaints and for improving surgical approaches. Our analysis shows that, whereas induced aberrations are minimal for simulated day-time vision (3-mm pupil), the increase in aberrations measured for simulated night vision (7-mm pupil) supports the use of large treatment zones to reduce visual disturbances such as glare and halos.
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