ROBERT MACHEMER: A PIONEER IN VISION Duke Eye Center Stephen J. Ryan April 30, 2010 Durham, NC
Robert Machemer • Visionary • Creative • Father of vitrectomy • Courage – first cases • Engineering and Medicine • Bascom Palmer and Duke • Teacher, colleague, and friend
Creativity vs. Problem Solving Novel Simple Elegant Effective Generative
Robert Machemer • Opened the Vitreous Space • Vitreo Retinal Surgeons • Endo Surgery • Intraocular and Other • Pathogenesis of R.D.
Vitreous Surgery • Opened whole new field • Educated many trainees Future Leaders • Generous with his time and encouragement • Stimulated ideas • Encouraged Critical Thinking
Research Influenced by Robert Machemer • Vitreous Surgery – Clinical and Research • Pathogenesis of Retinal detachment • Rhegmatogenous • Traction • Translational research patients • Many other areas
Clinical Research Animal Research Clinical Observations Clinical Practice Laboratory Research
Penetrating Ocular Injuries • Trauma model • Penetrating injuries – more detachments than blunt injuries • Penetrating injuries alone no R.D. • Blood alone no R.D. • Injury + Blood R.D.
TRACTION RETINAL DETACHMENT • WOUND HEALING
Clinical Management • Rhegmatogenous R.D. • After penetrating injury, two rows of 360 extensive cryotherapy to prevent RRD • Huge additional inflammatory stimulus • After Vitrectomy – different Rx • Vitrectomy Remove stimulus to inflammation and wound repair
Final Common Pathway Abnormal Vitreous Breakdown of Blood Retinal Barrier Migration Proliferation Contraction Traction Detachment Trauma PVR PDR
PATIENT CLINICIAN BASIC RESEARCH IDEA TRANSLATIONALRESEARCH COMMERCIALIZATION CLINICALRESEARCH
Robert Machemer • Visionary • Creative • Father of vitrectomy • Bascom Palmer and Duke • Teacher, colleague, and friend PIONEER