Micro-Cup Architecture for Printing and Coating Asymmetric 2d-Material-Based Solid-State Supercapacitors

High energy density micro-supercapacitors (MSCs) are in high demand for miniaturized electronics and microsystems. Research efforts today focus on materials development, applied in the planar interdigitated, symmetric electrode architecture. A novel "cup & core" device architecture that allows for printing of asymmetric devices without the need of accurately positioning the second finger electrode here have been introduced. The bottom electrode is either produced by laser ablation of a blade-coated graphene layer or directly screen-printed with graphene inks to create grids with high aspect ratio walls forming an array of "micro-cups". A quasi-solid-state ionic liquid electrolyte is spray-deposited on the walls; the top electrode material -MXene inks- is then spray-coated to fill the cup structure. The architecture combines the advantages of interdigitated electrodes for facilitated ion-diffusion, which is critical for 2D-material-based energy storage systems by providing vertical interfaces with the layer-by-layer processing of the sandwich geometry. Compared to flat reference devices, volumetric capacitance of printed "micro-cups" MSC increased considerably, while the time constant decreased (by 58%). Importantly, the high energy density (3.99 µWh cm-2 ) of the "micro-cups" MSC is also superior to other reported MXene and graphene-based MSCs.

Stable MXene Dough with Ultrahigh Solid Fraction and Excellent Redispersibility toward Efficient Solution Processing and Industrialization

Two-dimensional (2D) transition metal carbides, and/or nitrides, so-called MXenes, have triggered intensive research interests in applications ranging from electrochemical energy storage to electronics devices. Producing these functional devices by printing necessitates to match the rheological properties of MXene dispersions to the requirements of various solution processing techniques. In particular, for additive manufacturing such as extrusion-printing, MXene inks with high solid fraction are typically required, which is commonly achieved by tediously removing excessive free water (top-down route). Here, the study reports on a bottom-up route to reach a highly concentrated binary MXene-water blend, so-called MXene dough, by controlling the water admixture to freeze-dried MXene flakes by exposure to water mist. The existence of a critical threshold of MXene solid content (≈60%), beyond which no dough is formed, or formed with compromised ductility is revealed. Such metallic MXene dough possesses high electrical conductivity, excellent oxidation stability, and can withstand a couple of months without apparent decay, providing that the MXene dough is properly stored at low-temperature with suppressed dehydration environment. Solution processing of the MXene dough into a micro-supercapacitor with gravimetric capacitance of 161.7 F g^-1 is demonstrated. The impressive chemical and physical stability/redispersibility of MXene dough indicate its great promise in future commercialization.

Rational Design of Ti3C2Tx MXene Inks for Conductive, Transparent Films

Transparent conductive electrodes (TCEs) with a high figure of merit (FOM_e, defined as the ratio of transmittance to sheet resistance) are crucial for transparent electronic devices, such as touch screens, micro-supercapacitors, and transparent antennas. Two-dimensional (2D) titanium carbide (Ti₃C₂T_x), known as MXene, possesses metallic conductivity and a hydrophilic surface, suggesting dispersion stability of MXenes in aqueous media allowing the fabrication of MXene-based TCEs by solution processing. However, achieving high FOM_e MXene TCEs has been hindered mainly due to the low intrinsic conductivity caused by percolation problems. Here, we have managed to resolve these problems by (1) using large-sized Ti₃C₂T_x flakes (∼12.2 μm) to reduce interflake resistance and (2) constructing compact microstructures by blade coating. Consequently, excellent optoelectronic properties have been achieved in the blade-coated Ti₃C₂T_x films, i.e., a DC conductivity of 19 325 S cm^-1 at transmittances of 83.4% (≈6.7 nm) was obtained. We also demonstrate the applications of Ti₃C₂T_x TCEs in transparent Joule heaters and the field of supercapacitors, showing an outstanding Joule heating effect and high rate response, respectively, suggesting enormous potential applications in flexible, transparent electronic devices.

Unraveling Polysulfide's Adsorption and Electrocatalytic Conversion on Metal Oxides for Li-S Batteries

Lithium sulfur (LiS) batteries possess high theoretical capacity and energy density, holding great promise for next generation electronics and electrical vehicles. However, the LiS batteries development is hindered by the shuttle effect and sluggish conversion kinetics of lithium polysulfides (LiPSs). Designing highly polar materials such as metal oxides (MOs) with moderate adsorption and effective catalytic activity is essential to overcome the above issues. To design efficient MOs catalysts, it is critical and necessary to understand the adsorption mechanism and associated catalytic processes of LiPSs. However, most reviews still lack a comprehensive investigation of the basic mechanism and always ignore their in-depth relationship. In this review, a systematic analysis toward understanding the underlying adsorption and catalytic mechanism in LiS chemistry as well as discussion of the typical works concerning MOs electrocatalysts are provided. Moreover, to improve the sluggish "adsorption-diffusion-conversion" process caused by the low conductive nature of MOs, oxygen vacancies and heterostructure engineering are elucidated as the two most effective strategies. The challenges and prospects of MOs electrocatalysts are also provided in the last section. The authors hope this review will provide instructive guidance to design effective catalyst materials and explore practical possibilities for the commercialization of LiS batteries.

A Universal Approach for Room-Temperature Printing and Coating of 2D Materials

Processing 2D materials into printable or coatable inks for the fabrication of functional devices has proven to be quite difficult. Additives are often used in large concentrations to address the processing challenges, but they drastically degrade the electronic properties of the materials. To remove the additives a high-temperature post-deposition treatment can be used, but this complicates the fabrication process and limits the choice of materials (i.e., no heat-sensitive materials). In this work, by exploiting the unique properties of 2D materials, a universal strategy for the formulation of additive-free inks is developed, in which the roles of the additives are taken over by van der Waals (vdW) interactions. In this new class of inks, which is termed "vdW inks", solvents are dispersed within the interconnected network of 2D materials, minimizing the dispersibility-related limitations on solvent selection. Furthermore, flow behavior of the inks and mechanical properties of the resultant films are mainly controlled by the interflake vdW attractions. The structure of the vdW inks, their rheological properties, and film-formation behavior are discussed in detail. Large-scale production and formulation of the vdW inks for major high-throughput printing and coating methods, as well as their application for room-temperature fabrication of functional films/devices are demonstrated.

Enhanced Room-Temperature Photoluminescence Quantum Yield in Morphology Controlled J-Aggregates

Supramolecular assemblies from organic dyes forming J-aggregates are known to exhibit narrowband photoluminescence with full-width at half maximum of ≈9 nm (260 cm-1). Applications of these high color purity emitters, however, are hampered by the rather low photoluminescence quantum yields reported for cyanine J-aggregates, even when formed in solution. Here, it is demonstrated that cyanine J-aggregates can reach an order of magnitude higher photoluminescence quantum yield (increase from 5% to 60%) in blend solutions of water and alkylamines at room temperature. By means of time-resolved photoluminescence studies, an increase in the exciton lifetime as a result of the suppression of non-radiative processes is shown. Small-angle neutron scattering studies suggest a necessary condition for the formation of such highly emissive J-aggregates: the presence of a sharp water/amine interface for J-aggregate assembly and the coexistence of nanoscale-sized water and amine domains to restrict the J-aggregate size and solubilize monomers, respectively.

Nanocellulose-MXene Biomimetic Aerogels with Orientation-Tunable Electromagnetic Interference Shielding Performance

Designing lightweight nanostructured aerogels for high-performance electromagnetic interference (EMI) shielding is crucial yet challenging. Ultrathin cellulose nanofibrils (CNFs) are employed for assisting in building ultralow-density, robust, and highly flexible transition metal carbides and nitrides (MXenes) aerogels with oriented biomimetic cell walls. A significant influence of the angles between oriented cell walls and the incident EM wave electric field direction on the EMI shielding performance is revealed, providing an intriguing microstructure design strategy. MXene "bricks" bonded by CNF "mortars" of the nacre-like cell walls induce high mechanical strength, electrical conductivity, and interfacial polarization, yielding the resultant MXene/CNF aerogels an ultrahigh EMI shielding performance. The EMI shielding effectiveness (SE) of the aerogels reaches 74.6 or 35.5 dB at a density of merely 8.0 or 1.5 mg cm-3, respectively. The normalized surface specific SE is up to 189 400 dB cm2 g-1, significantly exceeding that of other EMI shielding materials reported so far.

Turning Trash into Treasure: Additive Free MXene Sediment Inks for Screen-Printed Micro-Supercapacitors

Printed functional conductive inks have triggered scalable production of smart electronics such as energy-storage devices, antennas, wearable electronics, etc. Of particular interest are highly conductive-additive-free inks devoid of costly postdeposition treatments to eliminate sacrificial components. Due to the high filler concentration required, formulation of such waste-free inks has proven quite challenging. Here, additive-free, 2D titanium carbide MXene aqueous inks with appropriate rheological properties for scalable screen printing are demonstrated. Importantly, the inks consist essentially of the sediments of unetched precursor and multilayered MXene, which are usually discarded after delamination. Screen-printed structures are presented on paper with high resolution and spatial uniformity, including micro-supercapacitors, conductive tracks, integrated circuit paths, and others. It is revealed that the delaminated nanosheets among the layered particles function as efficient conductive binders, maintaining the mechanical integrity and thus the metallic conductive network. The areal capacitance (158 mF cm^-2 ) and energy density (1.64 µWh cm^-2 ) of the printed micro-supercapacitors are much superior to other devices based on MXene or graphene. The ink formulation strategy of "turning trash into treasure" for screen printing highlights the potential of waste-free MXene sediment printing for scalable and sustainable production of next-generation wearable smart electronics.

Excitonic channels from bio-inspired templated supramolecular assembly of J-aggregate nanowires

Supramolecular assemblies with controlled morphology are of paramount importance for energy transport in organic semiconductors. Despite considerable freedom in molecular design, the preparation of dyes that form one dimensional J-aggregates is challenging. Here, we demonstrate a simple and effective route to functionalize dendronized polymers (DPs) with J-aggregates to construct tubular DP/J-aggregate nanowires. When J-aggregates are adsorbed onto DPs anchored to glass substrates, they assemble into microcrystalline domains typical for J-aggregates adsorbed on functionalized surfaces. Differently, the complexation between the dendronized polymer and J-aggregates in solution leads to dense packing of J-aggregate strands on the periphery of the DPs. Using a layer-by-layer (LBL) technique, DPs loaded with J-aggregates can also be adsorbed onto a DP monolayer. In this case, the thin film absorption spectra are narrower and indicate higher ratios of J-aggregate to monomer and dimer absorption than bare J-aggregates deposited similarly. The demonstration of J-aggregate adsorption on filamentous polymeric templates is a promising step toward artificial 1D light harvesting antennas, with potential applications in opto-electronic devices.

Superweak Coordinating Anion as Superstrong Enhancer of Cyanine Organic Semiconductor Properties

The superweak tetrakis(nonafluoro-tert-butoxy)aluminate coordinating anion was employed to introduce pseudo-gas-phase conditions to the 2-[5-(1,3-dihydro-1,3,3-trimethyl-2H-indol-2-ylidene)-1,3-pentadien-1-yl]-1,3,3-trimethyl-3H-indolium chromophore. The resulting formation of a photoactive organic-inorganic hybrid salt has led to a highly stabilized excited state of the organic chromophore mainly due to the minimized lattice energy and Coulomb interactions. These highly beneficial features caused by the well dispersed negative charge of the anion have led to an enhanced neat spin-casted film fluorescence intensity, prolonged fluorescence lifetime, smooth thin film surfaces and a record power photovoltaic efficiency of 3.8 % when compared to organic salts of this particular chromophore containing anions with localised negative charge. Clear evidence is given that a superweak coordinating anion is an emerging key parameter in cyanine dye photochemistry. This approach can be seen as a general guideline to prepare highly efficient ionic dyes for organic semiconductor applications.

Cyanine platelet single crystals: growth, crystal structure and optical spectra

Crystalline organic semiconducting materials are much in demand for multiple electronic and optoelectronic device applications. Here, solution grown ultrathin rhombic crystals of a trimethine carbocyanine anionic dye are used to establish relationships between structural and optical properties. The dye crystallized in the monoclinic space group P21/c featuring alternating layers of molecules in two different herringbone type patterns, with perchlorate counterions located mostly within one of the two layers. Micro transmittance spectroscopy revealed a broadened spectrum compared to those obtained in solution and in an amorphous thin film. Using polarized light, transmission spectroscopy revealed strong low-energy and weak high-energy bands polarized along the crystallographic b- and c-axis, respectively. Using the extended dipole approximation, significant exciton couplings are predicted between neighboring molecules in the crystal, of the order of the intrinsic monomer reorganization energies associated with nuclear relaxation after excitation, depicting a complex spectral scenario. The exciton coupling pattern explains the relative energies of the b- and c-polarized components but the observed intensities are opposite to expectations based on chromophore alignment within the crystal.

Insights into photovoltaic properties of ternary organic solar cells from phase diagrams

The efficiency of ternary organic solar cells relies on the spontaneous establishment of a nanostructured network of donor and acceptor phases during film formation. A fundamental understanding of phase composition and arrangement and correlations to photovoltaic device parameters is of utmost relevance for both science and technology. We demonstrate a general approach to understanding solar cell behavior from simple thermodynamic principles. For two ternary blend systems we construct and model phase diagrams. Details of EQE and solar cell parameters can be understood from the phase behavior. Our blend system is composed of PC₇₀BM, PBDTTT-C and a near-infrared absorbing cyanine dye. Cyanine dyes are accompanied by counterions, which, in a first approximation, do not change the photophysical properties of the dye, but strongly influence the morphology of the ternary blend. We argue that counterion dissociation is responsible for different mixing behavior. For the dye with a hexafluorophosphate counterion a hierarchical morphology develops, the dye phase separates on a large scale from PC₇₀BM and cannot contribute to photocurrent. Differently, a cyanine dye with a TRISPHAT counterion shows partial miscibility with PC₇₀BM. A large two-phase region dictated by the PC₇₀BM: PBDTTT-C mixture is present and the dye greatly contributes to the short-circuit current.

Multimodal general anesthesia approach for Ex Utero Intrapartum Therapy (EXIT) procedures: two case reports

High-dose volatile anesthesia is the most common method of achieving uterine relaxation for Ex Utero Intrapartum Therapy (EXIT) procedures. Other methods employ nitroglycerin for additional uterine relaxation with or without remifentanil for additional fetal analgesia. We report a combination approach including one minimum alveolar concentration of volatile anesthetic plus nitroglycerin and remifentanil infusions, to provide timely uterine relaxation under general anesthesia for both mother and fetus, during two EXIT procedures.

Increasing Photovoltaic Performance of an Organic Cationic Chromophore by Anion Exchange

A symmetrical cyanine dye chromophore is modified with different counteranions to study the effect on crystal packing, polarizability, thermal stability, optical properties, light absorbing layer morphology, and organic photovoltaic (OPV) device parameters. Four sulfonate-based anions and the bulky bistriflylimide anion are introduced to the 2-[5-(1,3-dihydro-1,3,3-trimethyl-2H-indol-2-ylidene)-1,3-pentadien-1-yl]-1,3,3-trimethyl-3H-indolium chromophore using an Amberlyst A26 (OH^- form) anion exchanger. Anionic charge distribution clearly correlates with device performance, whereby an average efficiency of 2% was reached in a standard bilayer organic solar. Evidence is given that the negative charge of the anion distributed over a large number of atoms is significantly more important than the size of the organic moieties of the sulfonate charge carrying group. This provides a clear strategy for future design of more efficient cyanine dyes for OPV applications.

Increasing Photovoltaic Performance of an Organic Cationic Chromophore by Anion Exchange

A symmetrical cyanine dye chromophore is modified with different counteranions to study the effect on crystal packing, polarizability, thermal stability, optical properties, light absorbing layer morphology, and organic photovoltaic (OPV) device parameters. Four sulfonate-based anions and the bulky bistriflylimide anion are introduced to the 2-[5-(1,3-dihydro-1,3,3-trimethyl-2H-indol-2-ylidene)-1,3-pentadien-1-yl]-1,3,3-trimethyl-3H-indolium chromophore using an Amberlyst A26 (OH^- form) anion exchanger. Anionic charge distribution clearly correlates with device performance, whereby an average efficiency of 2% was reached in a standard bilayer organic solar. Evidence is given that the negative charge of the anion distributed over a large number of atoms is significantly more important than the size of the organic moieties of the sulfonate charge carrying group. This provides a clear strategy for future design of more efficient cyanine dyes for OPV applications.

Combining parallel pattern generation of electrohydrodynamic lithography with serial addressing

Electrohydrodynamic lithography (EHDL) is a parallel patterning process which typically makes use of topographically structured electrodes to guide pattern formation along areas of higher electrical field strength. The main driving force for pattern formation is an electrostatic pressure acting on a thin film polymer surface caused by a voltage applied between a top and bottom electrode. We here demonstrate that the principle can be applied using an addressable electrode composed of interdigitated fingers. Depending on the applied voltages, line patterns with different periodicities were fabricated. Our proof-of-concept experiments pave the way for a parallel pattern replication process where a serially addressed master is used. We complement the experiments by modelling the potentials across the electrodes and electrostatic forces acting on the polymer surface using different addressing schemes. Numerical simulations of the experimental setup pointed to some critical issues we experienced during the design of the experiments.

Via different electrode addressing schemes in electrohydrodynamic lithography, different patterns were generated.

Ternary semitransparent organic solar cells with a laminated top electrode

Tinted and colour-neutral semitransparent organic photovoltaic elements are of interest for building-integrated applications in windows, on glass roofs or on facades. We demonstrate a semitransparent organic photovoltaic cell with a dry-laminated top electrode that achieves a uniform average visible transmittance of 51% and a power conversion efficiency of 3%. The photo-active material is based on a majority blend composed of a visibly absorbing donor polymer and a fullerene acceptor, to which a selective near-infrared absorbing cyanine dye is added as a minority component. Our results show that organic ternary blends are attractive for the fabrication of semitransparent solar cells in general, because a guest component with a complementary absorption can compensate for the inevitably reduced current generation capability of a high-performing binary blend when applied as a thin, semitransparent film.

Influence of chemically p-type doped active organic semiconductor on the film thickness versus performance trend in cyanine/C60 bilayer solar cells

Simple bilayer organic solar cells rely on very thin coated films that allow for effective light absorption and charge carrier transport away from the heterojunction at the same time. However, thin films are difficult to coat on rough substrates or over large areas, resulting in adverse shorting and low device fabrication yield. Chemical p-type doping of organic semiconductors can reduce Ohmic losses in thicker transport layers through increased conductivity. By using a Co(III) complex as chemical dopant, we studied doped cyanine dye/C₆₀ bilayer solar cell performance for increasing dye film thickness. For films thicker than 50 nm, doping increased the power conversion efficiency by more than 30%. At the same time, the yield of working cells increased to 80%. We addressed the fate of the doped cyanine dye, and found no influence of doping on solar cell long term stability.

Resonance light scattering in dye-aggregates forming in dewetting droplets

Small organic semiconducting molecules assembling into supramolecular J- and H- aggregates have attracted much attention due to outstanding optoelectronic properties. However, their easy and reproducible fabrication is not yet sufficiently developed for industrial applications, except for silver halide photography. Here we present a method based on aggregate precipitation during the phase separation and dewetting of the evaporating dye precursor solution. The smaller the precursor droplets, the more pronounced the J-aggregation. The aggregates cause the films to resonantly scatter incoming light. Because the dye aggregate extinction resonances have narrowest bandwidths, a wavelength selectivity is observed that exceeds the selectivity of localized surface plasmon resonances. The aggregation mechanism can be easily applied to periodically structured substrates, making the method appealing for photonic applications. We demonstrate this point with a 2D grating, where the narrow absorption range of the aggregates leads to wavelength specific (one color only) scattering.

Towards cancer cell-specific phototoxic organometallic rhenium(I) complexes

Over the recent years, several Re(I) organometallic compounds have been shown to be toxic to various cancer cell lines. However, these compounds lacked sufficient selectivity towards cancer tissues to be used as novel chemotherapeutic agents. In this study, we probe the potential of two known N,N-bis(quinolinoyl) Re(I) tricarbonyl complex derivatives, namely Re(I) tricarbonyl [N,N-bis(quinolin-2-ylmethyl)amino]-4-butane-1-amine (Re-NH₂) and Re(I) tricarbonyl [N,N-bis(quinolin-2-ylmethyl)amino]-5-valeric acid (Re-COOH), as photodynamic therapy (PDT) photosensitizers. Re-NH₂ and Re-COOH proved to be excellent singlet oxygen generators in a lipophilic environment with quantum yields of about 75%. Furthermore, we envisaged to improve the selectivity of Re-COOH via conjugation to two types of peptides, namely a nuclear localization signal (NLS) and a derivative of the neuropeptide bombesin, to form Re-NLS and Re-Bombesin, respectively. Fluorescent microscopy on cervical cancer cells (HeLa) showed that the conjugation of Re-COOH to NLS significantly enhanced the compound's accumulation into the cell nucleus and more specifically into its nucleoli. Importantly, in view of PDT applications, the cytotoxicity of the Re complexes and their bioconjugates increased significantly upon light irradiation. In particular, Re-Bombesin was found to be at least 20-fold more toxic after light irradiation. DNA photo-cleavage studies demonstrated that all compounds damaged DNA via singlet oxygen and, to a minor extent, superoxide production.

Growth and alignment of thin film organic single crystals from dewetting patterns

Studying and understanding the conditions under which organic semiconductors can be engineered to form aligned single crystals in thin films is of primary importance owing to their unique orientation-dependent optoelectronic properties. Efforts to reach this goal by self-assembly from solution-processed films have been rewarded only with limited success. In this article we present a new method to grow single crystalline thin films via solvent annealing. We identify solvate crystal growth in combination with a specific film dewetting morphology as key to successful fabrication of single crystals. Furthermore, these 2D single crystals can align on chemically patterned substrates to minimize their interfacial energy. We explore in situ the conditions for crystal formation and alignment.

Fast assembly of cyanine dyes into aggregates onto [6,6]-phenyl C61-butyric acid methyl ester surfaces from organic solvents

Supramolecular agglomerates of organic colorants based on noncovalent interactions are promising candidates for the development of sensors, optoelectronics, lighting, or photovoltaics. However, their fast and defect-free fabrication on large scales using low-cost technologies has proven elusive so far. Here, we introduce a so far unreported mechanism to induce molecular order in cyanine dyes within minutes from organic solvents by self-assembly. Spin coating blends of a cyanine dye and a soluble fullerene derivative ([6,6]-phenyl C(61)-butyric acid methyl ester (PCBM)) from apolar, aprotic solvents leads to phase-separated structures on the micrometer scale. With this superordinated phase structure, adjustment of dye aggregation is possible, leading to novel optical properties of the film emerging from dye self-assembly on the nanometer scale. In the primary process, semiporous PCBM domains act as nucleation sites for H-aggregates. H-aggregates can then be reconstructed into J-aggregates by dissolving PCBM from the film. Unexpectedly, the method even works for sterically hindered cyanine dyes that are known for their reduced tendency to aggregate. Additionally, selective removal of H-aggregates leaves a template of PCBM nanocrystals, onto which cyanine dye monomers readsorb from solution, forming H-aggregates of similar quality.

Nanoscale structuring of semiconducting molecular blend films in the presence of mobile counterions

The controlled fabrication of submicrometer phase-separated morphologies of semiconducting organic materials is attracting considerable interest, for example, in emerging thin-film optoelectronic device applications. For thin films of spin-coated blends of PCBM ([6,6]-phenyl-C 61-butyric acid methyl ester) and cationic cyanine dyes, we used atomic force microscopy scans to infer the structure formation mechanism: The solutions separate into transient bilayers, which further spinodally destabilize because of long-range molecular interactions. A thin layer ruptures earlier than a thick layer, and the earlier instability determines the morphology. Consequently, the resulting morphology type mainly depends on the ratio of the layer thicknesses, whereas the periodicity of structures is determined by the absolute film thickness. These findings allow control of the feature sizes, and nodular domains with diameters well below 50 nm were produced. Films prepared with dyes possessing a mobile counterion were always unstable. To rationalize the findings, we developed a thermodynamic model showing that electrostatic forces induced by the mobile counterions act as destabilizing pressure.

[Surgical indications in intraosseous lipoma of the calcaneus. Case report and critical review of the literature]

Intraosseous lipomas represent a small number of benign bone tumors with incidence rates of approximately 0.1%. In about 15% these neoplasias are localized within the calcaneus, mostly at Ward's triangle. The tumors usually remain clinically inapparent and diagnosis is often obtained incidentally. Although CT scan and MRI provide specific and sensitive diagnostic tools that can distinguish morphology and dignity, surgical treatment is not standardized yet. In conjunction with a case report, we summarize and critically compare current treatment strategies.

Ketorolac tromethamine 0.5% ophthalmic solution in the treatment of moderate to severe ocular inflammation after cataract surgery: a randomized, vehicle-controlled clinical trial

PURPOSE

To investigate the efficacy and safety of ketorolac tromethamine 0.5% ophthalmic solution (Acular; Allergan, Inc, Irvine, California) in the treatment of moderate to severe anterior segment inflammation developing after unilateral cataract surgery with intraocular lens implantation.

METHODS

Only patients who exhibited moderate or greater levels of cells and flare 1 day after surgery were included in this multicenter, double-masked, randomly assigned, parallel-group study. Topical ketorolac or vehicle solution (Allergan, Inc) was administered to the treated eye four times daily, starting the day after surgery and continuing for 14 days.

RESULTS

Ketorolac was significantly more effective than the vehicle solution in reducing anterior chamber cells (P < or = .030) and flare (P < or = .025), conjunctival erythema (P < or = .046), ciliary flush (P < or = .006), tearing (P < or = .012), photophobia (P < or = .014), and pain (P < or = .049). Half as many patients from the ketorolac group (14/51) were discontinued from the study for lack of efficacy, compared with the vehicle group (28/51; P = .005). There was no significant difference between ketorolac and the vehicle solution in changes in visual acuity, intraocular pressure, biomicroscopic or ophthalmoscopic variables, or adverse events.

CONCLUSIONS

Ketorolac tromethamine 0.5% ophthalmic solution is safe and provides substantial anti-inflammatory activity in the treatment of moderate to severe anterior segment inflammation developing after cataract surgery and intraocular lens implantation.

Long-term follow-up of iatrogenic phototoxicity

OBJECTIVE

To evaluate the outcomes of a group of patients who suffered iatrogenic phototoxic injury.

METHODS

The medical records of 24 patients (24 eyes) with iatrogenic phototoxicity from 3 medical centers were reviewed. We report the findings from long-term follow-up of these patients with particular attention to visual outcome, type and duration of procedure, and location of the phototoxic lesion.

RESULTS

Phototoxic injury occurred after anterior segment surgery in 20 eyes and after vitrectomy in 4 eyes. The mean duration of surgery was 109 minutes; there was no statistically significant difference in duration between the anterior segment procedures and the vitrectomies. Mean final visual acuity was 20/40 for all cases (range, 20/15 to counting fingers) and 20/25 for all anterior segment cases. In vitrectomized eyes, the mean final visual acuity was 20/900. Phototoxic lesions tended to spare the fovea after anterior segment surgery and involve the foveal center after vitrectomy.

CONCLUSIONS

In general, patients who suffer phototoxicity do well, and the prognosis is good for extrafoveal lesions. Foveal injury, which often occurs with vitrectomy, usually leads to a worse visual outcome. The development of choroidal neovascularization may have an effect on the ultimate visual outcome as well.

Ocular and ocular adnexal injuries treated by United States military ophthalmologists during Operations Desert Shield and Desert Storm

BACKGROUND

Ocular and ocular adnexal injuries, both combat-related and accidental, are common during wartime. In a combat setting, the eye is particularly vulnerable to serious injury from tiny flying particles that might minimally affect other parts of the body. The purpose of this study is to examine the incidence of serious ocular and ocular adnexal injuries that occurred during Operations Desert Shield and Desert Storm.

METHODS

The authors retrospectively reviewed serious ocular and ocular adnexal injuries treated by United States Army and Navy ophthalmologists that occurred during Operations Desert Shield and Desert Storm. Only those injuries that resulted in, or would have resulted in, hospital admission because of the ocular or ocular adnexal injury alone are presented.

RESULTS

During Desert Shield, 20 patients (23 eyes) suffered serious ocular or ocular adnexal injuries compared with 160 patients (198 eyes) in Desert Storm. During Desert Storm, 78% of all serious injuries were caused by blast fragmentation from munitions. More than one third of the 98 globe lacerations reported in this article were 10 mm or less in size. Of 35 enucleations performed during Desert Storm, 94% were the result of munitions fragments.

CONCLUSIONS

During Operation Desert Storm, fragmentation wounds from munitions were the most common cause of ocular and ocular adnexal morbidity. The authors' findings indicate that polycarbonate ballistic protective eyewear could have prevented many of the ocular injuries that they report.