Eyeworld

EW MEETING REPORTER 74 May 2018 Reporting from the 2018 ASCRS•ASOA Annual Meeting, April 13–17, 2018, Washington, D.C. on a "whirlwind tour through vitre- oretinal surgery." Dr. Charles went through the evolution of various ad- vances that have occurred over the years in this field, showcasing where the technology or technique started and how it was improved and added onto in subsequent iterations. Aspiration fluidics, for example, started with a manual syringe op- erated by an assistant developed by Robert Machemer, MD. From there Dr. Charles developed a rack and pinion syringe device that was oper- ated by the surgeon. This was built upon by Conor O'Malley, MD, and Ralph Heinz with foot pedal con- trol with an on-off aspiration. Dr. Charles and Carl Wang, PhD, then improved upon that with a faster response time processor, followed by Dr. Charles creating the company InnoVision (acquired by Alcon, Fort Worth, Texas) to create a smaller, faster, auto-emptying chamber in a real-time operating system that would become the Accurus Surgical System (Alcon). This all accumulated to the Constellation Vision System (Alcon), which includes an aspira- tion chamber with three proportion- al values (two vacuum, one pres- sure), and it is servo controlled with a fluid level that's optically sensed for flow control and auto emptying. The development of Accurus and Constellation came with sys- tems innovation and Dr. Charles' drive to take all of the prior func- tions that he previously discussed and put them into one box with one control and a smarter user interface. Similarly, Dr. Charles described the evolution of epiretinal mem- brane peeling. Membrane peeling was initially done with a bent needle. The problem was that the needle could penetrate the reti- na; this led to the development of membrane peeling with a pick. Membrane peeling with a pick could be difficult, however, because the epiretinal membrane could slip off the needle or pick. This is what led Dr. Charles to develop forceps that were truly grasping for peeling in a single step procedure. It didn't stop there, though. The membrane could slip out of the forceps as well, so Dr. Charles drops, is nearly complete. The com- mittee and working group involved with this study is nearly done with grant writing and has engaged with a variety of stakeholders including the National Institutes of Health, Food and Drug Administration, Vet- eran's Administration, and potential corporate partners. Site selection has not yet occurred. If the committee's hypothesis is proven correct, Dr. Rhee said the research would change postoperative management of endophthalmitis prevention for all cataract surgery patients. It also would have the potential to provide a better patient experience postoperatively. Steve Charles, MD, delivers Charles D. Kelman, MD, Innovator's Lecture The Charles D. Kelman, MD, Inno- vator's Lecture honors an individual whose hard work, creativity, and innovation advance the field of ophthalmology. This year's lecturer, Steve Charles, MD, Memphis, Ten- nessee, is a renowned vitreoretinal surgeon who has invented a signif- icant number of technologies and devices that have impacted the field and patient care. "I went into medicine to do microsurgery and do engineering for medical devices," Dr. Charles ex- plained, and his lecture focused on the synergistic relationship that can exist between these two fields. "Techniques do not work without technologies. You can't do phaco without surgical technologies. The thing that I want to emphasize is the evolutionary nature of the process, the iterative nature, the col- laborative nature of the process. … If surgeons and engineers collaborate, multiple surgeons and engineers, and we keep the patient and patient outcomes in mind, that's when good things happen," Dr. Charles said. "There are hardly any techniques that exist in isolation where one person thought of it. What happens is complexity goes up." He said the collaboration among industry, engineers, and surgeons is "tantamount to progress." This was the theme of Dr. Charles' lecture, as he took attendees "This association is about the sharing of information and ideas, some ideas that can be quite provoc- ative, but that's the open nature of this society," Mr. Speares said of ASCRS, adding later that his aim is to help members harness the natural electricity and passion they have for what they do and capture it. He said he would like to see members get involved, share their ideas, and make them yours. "This is your society, this is your foundation, but I hope most of all you look at this as your home." Following, Douglas Rhee, MD, Cleveland, took to the podium as the first presenter, speaking about the purpose and current status of the ASCRS endophthalmitis clinical study, or the Topical vs. Intracameral Moxifloxacin for Endophthalmitis Prophylaxis study (TIME study). While there are traditional approaches to endophthalmitis prevention, such as povidone iodine sterile prep preoperatively, antibi- otics (delivered a variety of ways) immediately postoperatively, and postoperative topical antibiotics using third- or fourth-generation fluoroquinolones, more recently, there has been increased interest in intracameral antibiotics. A widely cited study conducted by ESCRS showed the superiority of intraca- meral cefuroxime, and intracameral vancomycin was commonly used in the U.S. prior to awareness of its association with the rare but devas- tating complication hemorrhagic oc- clusive retinal vasculitis. Since then, those favoring intracameral antibiot- ics in the U.S. might have switched to moxifloxacin, but there is only retrospective evidence to support its use and no approved pharmaceutical product, Dr. Rhee said. As such, the ASCRS Research Committee set out to design a study with the hypothesis that intracamer- al moxifloxacin is superior to topical moxifloxacin for the prevention of postoperative endophthalmitis. The study design, which will involve a control group receiving a placebo intracameral injection and topical moxifloxacin drops and an experimental group receiving intra- cameral moxifloxacin and placebo Sponsored by

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