This year the American Society of Retina Specialists’ Annual Meeting was held in Maui, Hawaii from October 10th to 15th. It was well-attended and provided an excellent overview of the recent advancements in our field.
Diabetic retinopathy
Diana Do, MD reported on the 6 month results of the READ-2 study, in which she reported that patients with diabetic macular edema (DME) obtained better visual outcomes when treated with ranibizumab monotherapy, than with focal laser, or a combination of ranibizumab and focal laser.
There were several reports from the DRCR.net clinical trials. Michael Ip, MD, reported that patients with DME had more visual benefit when treated with focal laser, than with intravitreal triamcinolone, and reaffirmed the role of focal laser in the management of DME. Julia Haller, MD, discussed results of patients undergoing vitrectomy for DME, in the DRCR study. About 50% of patients were unresponsive to previous therapies, and 70% had posterior hyaloidal traction. After vitrectomy, the macular thickness on OCT improved, and the study is ongoing.
Vincent Hau, MD presented a genotype study on patients with proliferative diabetic retinopathy and end-stage renal disease. The group found that rs1617640 in the EPO promoter is significantly associated with PDR and ESRD.
Retinal vein occlusion
Several investigators reported on the use of intravitreal bevacizumab for the treatment of retinal vein occlusions. Sundeep Dev, MD and Arif Samad, MD, both reported that it was safe and effective in reducing macular edema due to central retinal vein occlusions (CRVO). Sean Andrean reviewed the promising results of a retrospective study of patients receiving focal laser and intravitreal bevacizumab for branch retinal vein occlusion (BRVO). Emmanouil Mavrikakis, MD, reported that in 10 of 10 eyes with anterior segment neovascularization and neovascular glaucoma, new vessels regressed within 1 week, reducing intraocular pressure and facilitating panretinal photocoagulation. Dante Pieramici, MD reported on the design of the BRAVO and CRUISE trials, of ranibizumab for CRVO and BRVO.
Surgical Techniques
Mark Hammer, MD discussed the technique and pitfalls of direct perfluoro-octane to silicone oil exchange in retinal detachment surgery. William Aldred gave tips on the use of silicone oil in 25-gauge vitrectomy. Several groups discussed outcomes of different gauge vitrectomies. Colin McCannel, MD reported on 20, 23 and 25 –gauge surgical results for retinal detachment surgery with vitrectomy (with or without a buckle) from the Mayo Clinic. The primary success rate was 92% with an overall success rate of 100%, and instrument gauge did not affect the success rate. Richard Feist, MD, presented a series from Alabama, in which 25-gauge surgery for retinal detachment had a lower rate of recurrent detachment than 20-gauge surgery. Howard Fine, MD reported on the outcomes of surgery following massive hemorrhagic retinal detachment. Although prognosis was poor, patients had a meaningful improvement in vision at 1 year.
Mark Humayun, MD, reported results from the Argus II feasibility study using a 60-Electrode epiretinal prosthesis. Patient enrolled had end-stage retinitis pigmentosa, and all implants have been functioning and patients have shown an improvement in task performance.
Pharmacology
Tarek Hassan, MD, presented data to show that preoperative intravitreally injected autologous plasmin enzyme can enhance posterior vitreous detachment (PVD) development and vitreous liquefaction. Peter Stalmans, MD, presented results of the MIVI-IIT trial, a phase 2 trial using microplasmin to induce a PVD in patients with vitreomacular traction. Steven Schwartz, MD, presented results of the MIVI-III trial. This included patients with other indications for vitrectomy, such as macular holes, who were treated with varying doses of microplasmin prior to vitrectomy. Microplasmin showed encouraging results to support the future of non-surgical induction of a PVD.
Anne Fung, MD, presented the results of a phase I study of the Verisome system, a sustained release drug delivery system, containing triamcinolone, that is injected intravitreally through a 30 gauge needle, The data showed promising safety and efficacy results in eyes with cystoid macular edema.
Nancy Holekamp, MD, discussed how and why the vitreous consumes oxygen. A vitreous sample was obtained from patients undergoing vitrectomy, and tested for ascorbic acid concentration. Gel vitreous had a higher concentration of ascorbic acid than liquefied vitreous. She noted that after vitrectomy, the vitreous loses ascorbic acid and the ability to consume oxygen. This may provide insight into future therapies for prevention of post-vitrectomy cataract.
Awards
This year awards were presented to several distinguished members of the field. Neil and Susan Bressler, MD, were the recipients of the Gertrude Pyron Award Lecture. They discussed the evolution of randomized clinical trials in Retina. The Founders Award Lecture was given to Alexander Brucker, MD, who presented an overview of the most important contributions to the field, and how they have shaped our specialty. Stanley Chang, MD was presented with the Crystal Apple Award, and he gave a lecture to the Young Physicians Section on selection of the best procedure to repair a retinal detachment.
The vitreoretinal field continues to evolve, and this year’s ASRS was once again an excellent forum for discussion of the best therapies and techniques to treat our patients. We look forward to further refinement of these treatments, and hope to hear more next year!
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