Abstract
30th Anniversary Annual Scientific Meeting of the American Society of Retinal Specialists
Las Vegas, NV, USA, 25–29 August 2012
The 30th Anniversary Annual Conference of the American Society of Retinal Specialists (ASRS) was held in August 2012 at the Aria Resort in Las Vegas, NV, USA. The annual meeting is one of the premier updates in medical and surgical retina. Members of the ASRS, residents, nonmember fellows in training and guests sponsored by an ASRS member in attendance are able to attend this annual meeting.
The meeting began on Saturday 25th August 2012 with updates on uveitis, glaucoma and neuro-ophthalmology given by Narsing Rao (Doheny Eye Institute, CA, USA), Rohit Varma (Doheny Eye Institute) and Anthony Arnold (Jules Stein Eye Institute, CA, USA). These presentations focused on diagnosis and management of conditions which may present to retina specialists. The late afternoon featured a series of lively case presentations from fellows and attendees with numerous photographs and videos of surgical techniques. A welcome reception brought opportunities for reconnecting with friends and colleagues within the retina community.
Platform presentations began on Sunday with age-related macular degeneration. Zohar Yehoshua (Bascom Palmer Eye Institute, FL, USA) and Philip Rosenfeld (Bascom Palmer Eye Institute) presented results of the COMPLETE study, which showed that systemic complement inhibition with eculizumab does not slow growth of geographic atrophy or drusen volume with 6 months of follow-up. Brandon Busbee (Tennessee Retina, TN, USA), SriniVas Sadda (Doheny Eye Institute) and Karl Csaky (Texas Retina Associates, TX, USA) spoke for the HARBOR study group. Busbee showed Lucentis® (Genentech, CA, USA) injections resulted in better outcomes in younger patients, worse baseline visual acuity and smaller proportion of occult choroidal neovascularization. Sadda stated that patients with persistent subretinal fluid 7 days postinjection were more likely to gain three lines of vision at 1 year than patients without subretinal fluid at day 7. This may be because these patients have a greater potential for improvement. Csaky presented data showing that visual acuity does not correlate with choroidal neovascularization size. Anne Fung (Pacific Eye Associates, CA, USA) then described the results of the HiPED study that showed 2 mg of Lucentis injected monthly or nearly monthly can flatten pigment epithelial detachments and result in improved visual acuity.
Awards were presented to Dan Martin (Cleveland Clinic, OH, USA) and David Parke II (American Academy of Ophthalmology, OK, USA). Martin gave insight into the 2-year results of the Comparison of Age-Related Macular Degeneration Treatment Trial. Overall, Avastin® (Genentech) and Lucentis seem to be equivalent, but in finer details, Martin said individual physicians can find evidence to justify any of the studied treatment regimens. Systemic adverse events were slightly more common in the group treated with Avastin. Monthly arms showed a small but significant visual acuity gain over PRN arms (2.4 letters). He also mentioned the large cost difference between the two agents. Parke discussed the upcoming changes in the US healthcare system and the implications for retina specialists.
During the macular surgery symposium, Ray Iezzi (Mayo Clinic, MN, USA) generated much discussion when he reported a 100% macular hole closure rate without face down positioning in a consecutive series of 46 eyes. He peels the internal limiting membrane from arcade to arcade, fills the eye with 20% SF6 gas and instructs patients to spend the majority of the first 3 postoperative days reading. In the future, macular holes may not be managed with surgery but rather with enzymatic vitreolysis. Carl Regillo (Thomas Jefferson University, PA, USA) and Baruch Kuppermann (University of California, CA, USA) described the results of the recently published Phase III trial of ocriplasmin for symptomatic vitreomacular traction (VMT) and macular hole. The drug resolved 29% of VMT cases and 40% of macular holes compared with 10% in the control group.
During the imaging session, Justis Ehlers (Cleveland Clinic) and Paul Hahn (Duke Eye Center, NC, USA) described findings from intraoperative optical coherence tomography (OCT) which expand the authors understanding of changes to the retinal microanatomy induced by surgery. Hahn showed that a microscope-mounted OCT showed high correlation with findings from a handheld model and that images could easily be acquired by surgeons. During the retinal vascular symposium, Emily Chew (National Eye Institute, MD, USA) suggested that macular telangiectasia may be a neurodegenerative disease because autopsy specimens show loss of Müeller cells. David Boyer (iCo Therapeutics Inc., CA, USA) discussed results from the COPERNICUS study showing aflibercept was effective at reducing macular edema from central retinal vein occlusion. As has been found in other studies of retinal vein occlusion, delay in treatment in the sham arms was detrimental to final visual acuity. Finally, the authors of this article presented retrospective, noncomparative data demonstrating improvement in visual acuity and decreased subretinal fluid using oral valproic acid for the treatment of chronic central serous chorioretinopathy.
The third day of the conference began with a symposium on diabetic retinopathy. David Brown (Retina Consultants, TX, USA) presented the 36-month safety and efficacy results of RISE and RIDE trials. 0.3 and 0.5 mg of ranibizumab led to substantial decreases in macular thickness and improvement in visual acuity of ten to 14 letters over 3 years in patients with diabetic macular edema. He also demonstrated a delay in the time to development of PDR with an excellent safety profile. Hugo Quiroz-Mercado (Denver Health Medical Center, CO, USA) presented a Phase I study of intravitreal injection of a synthetic integrin oligopeptide for diabetic macular edema. Several patients demonstrated improved visual acuity and decreased macular thickness. Abdhish Bhavsar (Retina Center, MN, USA) presented cases of endophthalmitis following intravitreal injections in the DRCR.net study with and without topical antibiotics. The study found similar rates of endopthalmitis in both groups and concluded that topical antibiotics were not necessary for intravitreal injections. Rodrigo Jorge (University of São Paulo, Brazil) presented results of a prospective randomized trial of bevacizumab versus ranibizumab for diabetic macular edema. Both medications resulted in decreased central subfield thickness and improvement in vision over 48 weeks although fewer injections of ranibizumab were required compared with bevacizumab to achieve this effect.
After two short sessions on ocular oncology and socioeconomic issues, the conference continued with the second age-related macular degeneration (AMD) session. Initially, Allen Ho (Thomas Jefferson University) presented the 96 weeks results from the VIEW 1 and VIEW 2 studies of intravitreal aflibercept versus ranibizumab for neovascular AMD. A total of 2457 patients were randomized to the treatment arms, all of which achieved a similar effect. There was faster resolution of fluid in patients receiving the higher dose of aflibercept (2 mg), either every 4 weeks or every 8 weeks. The remainder of the discussion centered on initial experiences with aflibercept in patients with chronic or recalcitrant wet AMD. While many patients who did not respond to bevacizumab or ranibizumab responded to aflibercept, other patients continued to show no response.
The final session was the first retinal surgery symposium. Mark Humayun (University of Southern California, CA, USA) presented 2-year results from the Argus II retinal prosthesis clinical trial. A total of 27% of patients had greater than three lines of visual improvement. One patient even demonstrated 20/200 vision with magnification and some color discrimination. Matthew Ohr (Clevelend Clinic) presented clinical results of intraoperative ocular coherence tomography during macula-off retinal detachment repair. The third day of the conference concluded with a poster session in the exhibit hall.
The fourth day of the conference began with a short trauma session, followed by an inflammation symposium. Fernando Arevalo (John Hopkins School of Medicine, MD, USA) reviewed 727 eyes of 400 patients with panuveitis treated in Saudi Arabia over 25 years. A total of 73% of the patients had bilateral disease, 60% had recurrent disease and 38% had visual acuity worse than 20/200; 45% of the patients required surgery. Sunil Srivastava (Cleveland Clinic) reported a pool of 1170 eyes in three large studies comparing fluocinolone acetonide implant versus systemic therapy for noninfectious uveitis. While implanted eyes had worse visual acuity at baseline, they were more likely to have two lines of visual acuity improvement and fewer recurrences over 2 years. Implanted eyes did have a higher rate of cataract and glaucoma surgery. Juan Romero (Long Island Vitreo Retinal, NY, USA) shared a report of patients experiencing endophthalmitis after intravitreal anti-VEGF injection. Overall, patients who required pars plana vitrectomy had a poorer outcome.
The third AMD symposium followed. Bailey Freund (New York University School of Medicine, NY, USA) presented data indicating that patients receiving intravitreal ranibizumab were more likely to have intraocular pressure elevation compared to patients receiving intravitreal aflibercept. Gregg Kokame (Eye Surgery Center, HI, USA) presented a prospective study of 14 eyes with active polypoidal choroidal vasculopathy receiving monthly, high-dose ranibizumab (2.0 mg). Many patients showed significant decreases in macular thickness and subretinal fluid and increases in visual acuity.
Steve Charles (Charles Retina Institute, TN, USA) presented results of a prospective study using a new, medium-term perfluoro-N-octane during the second retinal surgery symposium. He used the perfluoro-N-octane to manage patients with recurrent inferior retinal detachment and grade C proliferative vitreoretinopathy; 86% of the eyes were successfully repaired. Alok Bansal (Mills Peninsula Medical Center, CA, USA) showed a series of eight patients who underwent pars plana vitrectomy for macula-sparing rhegmatogenous retinal detachment and subsequently developed optic neuropathy. These patients had poor visual acuity, optic nerve pallor and afferent pupillary defects. Bansal hypothesized that this rare complication of surgery may be due to reduced intraocular perfusion. The fourth day of the conference concluded with small group break-out sessions covering a variety of topics.
The meeting concluded with sessions on Wednesday morning, starting with macular surgery and anterior segment surgery. Amani Fawzi (Northwestern University, IL, USA) studied a series of patients with foveal dystopia from an epiretinal membrane. She found that preoperative visual acuity correlated with the amount of foveal displacement. Vision recovered with surgery in some but not all patients, and the fovea did not completely return to its expected location. Vishak John (Bascom Palmer, CA, USA) retrospectively studied the natural history of eyes with VMT. He found that many patients had stable anatomy and visual acuity over an average of 20 months suggesting many patients can safely be observed without surgery. Ching Chen (University of Mississippi, MS, USA) performed intraoperative OCT on patients undergoing surgery for epiretinal membrane. Only after internal limiting membrane peeling did retinal folds seem to disappear.
During the final AMD symposium, Jennifer Lim (University of Illinois, IL, USA) shared the results of a pilot study of ten patients in whom a sustained-release intravitreal implant delivering triamcinolone significantly reduced as Lucentis injections were needed. Intraocular pressure elevations occurred in eight patients but were managed with drops. Developments in pediatric retina included promising results for ocriplasmin in inducing posterior hyaloid separation prior to vitrectomy (presented by Michael Trese, Oklahoma University, MI, USA) and good results and safety profile in 212 neonates with retinopathy of prematurity treated with intravitreal Avastin (presented by Maria Martinez-Castellanos, Association Para Evitar La Ceguera En Mexico, Mexico). Martinez-Castellanos warned against using the drug in patients with tractional detachments as these cases can progress postinjection. In the final session on instrumentation and pharmacology, Clement Chow (Retinal Specialists of Michigan, MI, USA) showed that microperimetry may be abnormal in patients on hydroxychloroquine even without other signs of maculopathy. Thomas Aaberg Jr (MI, USA) described his initial experience with a portable small-gauge vitrectomy device including six macular cases requiring membrane peeling.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.