Robert Machemer, MD Photo Courtesy of Harry W. Flynn, Jr., MD, FASRS
Contributed by J. Michael Jumper, MD, FASRS
Robert Machemer, MD, lived an extraordinary life driven by intellectual curiosity and tenacity. He overcame the challenges of growing up in war-torn Germany and the untimely death of his father to receive a medical degree from the University of Münster and complete ophthalmology residency training at the University of Göttingen.
Dr. Machemer's academic potential was recognized early, and he received a NATO fellowship to study in the United States at the Bascom Palmer Eye Institute where, 2 years later, he accepted a faculty position.
It was in Miami, with the collaboration and support of colleagues including Drs. Ed Norton, Helmut Buettner, and Jean-Marie Parel, that Dr. Machemer developed the instrumentation and techniques of vitreous gel removal. His first pars plana vitrectomy was performed on April 20, 1970 for a patient with a chronic diabetic vitreous hemorrhage. His initial success with this case encouraged him to continue.
Over the ensuing years, Dr. Machemer and his colleagues made many advances in instrumentation that vitreoretinal surgeons take for granted today, including fiberoptic intraocular lighting as well as beam-splitting and foot-pedal control of the operating microscope.
Edward W.D. Norton, MD and Robert Machemer., MD Photo courtesy Harry W. Flynn, Jr., MD, FASRS
Robert Machemer's innovation and research were only a part of his success. In 1978, he became chairman of the Department of Ophthalmology at the Duke University Medical Center. For the rest of his career, he helped the department gain prominence in ophthalmic research, the delivery of eye care, and the training of residents and fellows. Dr. Machemer was quick to credit the many people who supported his remarkable career, and many in the vitreoretinal community have him to thank for their accomplishments.
highlights
1966
Selected as a NATO Research Fellow, Bascom Palmer Eye Institute
Chairman, Department of Ophthalmology, Duke University Eye Center
Professor of Ophthalmology, Duke University
Professor, Bascom Palmer Eye Institute, University of Miami School of Medicine
Education & Training
Fellowship: NATO Research Fellow at Bascom Palmer Eye Institute
Residency: University of Goettingen, Germany
Medical School: University of Münster, University of Freiburg, Germany
Reflections
Steve Charles MD
Robert Machemer, MD; W. Darrell Willerson, Jr., MD; Steve Charles, MD, FASRS; and Ron Michels, MD attend the 1976 Milwaukee Vitrectomy Course. Photo courtesy of H. Michael Lambert, MD
The worldwide vitreoretinal community and our patients are eternally indebted to Robert Machemer for introducing pars plana vitrectomy and teaching us the many applications. I was fortunate to be a resident at Bascom Palmer Eye Institute during the early years and did research with Robert on photoreceptor outer-segment loss using his experimental retinal detachment model.
At the direction of Dr. Edward W.D. Norton, Robert Machemer taught me vitrectomy during an extended retina rotation so I could develop a vitreoretinal surgery program at the National Eye Institute. I participated in many vitreoretinal surgery courses with Dr. Machemer at Duke, Wilmer, and Milwaukee.
There was a period when there was contentious competition between us, so I sent a birthday cake with 25 candles to Robert on the 25th birthday of vitrectomy, which restored the friendly, collegial relationship that began in Miami. I was asked by Drs. Cynthia Toth and Glenn Jaffe to speak at Robert’s memorial service about how his revolutionary concepts led to my evolutionary techniques and technologies.
Vitrectomy followed by gas injection led to my development of fluid-air exchange and air-gas exchange. Robert Machemer’s bent-needle membrane peeling led to my forceps membrane peeling as well as scissors segmentation and delamination. His endo-cryopexy led to my endophotocoagulation. We simultaneously and independently developed relaxing retinotomy and retinectomy as well subretinal surgery. Robert Machemer’s dedication to teaching, research and collaboration is a great example for all of us.
Photo courtesy of Eugene de Juan Jr, MD
Eugene de Juan Jr, MD
It’s nearly impossible for me to measure—or even relate to—the impact that Robert Machemer has had on my life.
Even before I had been accepted into a residency, my ophthalmologist father suggested that I work with “this guy, Machemer, down in Miami—he knows things that others don’t.” So it was a real achievement for me to have been selected as a fellow at Duke to work with Machemer. After 3 months, Machemer made me an offer to stay on as faculty.
This was the biggest change in the direction of my life. Two roads diverged; I chose to follow Machemer, and that has made all the difference.
For 9 years, I experienced the pleasure of working on a team, Robert’s ability to tolerate my passion and hardheadedness, and his offers of friendship and guidance.
I loved his thinking, I loved his hard work, I loved his values, I loved his guidance. Of course, no one is perfect—but at that moment, Machemer at Duke was. It changed everything for me.
Machemer had established a school. We all see it; we all have benefited from it. I was proud to be an acolyte. Literally millions of patients have as well.
Thank you, Robert. For all.
Brooks W. McCuen II, MD
One of the many things I learned over the years in working with Robert Machemer is that he did not believe in the old adage, “If it isn’t broken, don’t fix it.” Robert’s entire professional life was built around his determination to find better ways to understand and treat retinal diseases. He was never satisfied with the status quo, and had no fear of facing challenges others may have considered impossible if he felt it may lead to a better way.
Even in the beginning of his career, these qualities were readily apparent. He was not content to stay in his native Germany; instead, Robert accepted the invitation of Edward Norton, MD, at the Bascom Palmer Eye Institute to come to the United States as a research fellow in 1966. Robert’s project was to try to unravel the mysteries of retinal detachment development and treatment.By 1966, the success rate in treating conventional retinal detachments was pretty good—but not good enough for Robert. There must be a better way!
Working with an experimental model he devised, Robert began to answer some basic questions about retinal detachment—and in so doing, he taught the world the importance of cellular proliferation in understanding and treating complicated retinal detachments.
At the same time, David Kasner, MD, also working in Miami, showed it was possible to improve vision in some patients by removing the vitreous gel. To do this, however, Dr. Kasner first had to remove the cornea and the lens. Stimulated by Dr. Kasner’s observations, Robert set out to improve the technique. There must be a better way!
Robert worked with Jean-Marie Parel to pioneer the development of pars plana vitreous surgery, to the enormous benefit of countless patients afflicted with previously blinding conditions.
Robert’s enormous skills as an educator were at least as impressive as his intellectual and technical contributions to retinal disease treatment. He loved to teach and was among the best ever to have taught ophthalmology. I am among the countless residents and fellows who have benefited from his style of teaching, as he instilled in us the importance of looking for better ways by questioning concepts we had previously accepted without critical examination.
Robert’s teaching touched countless more physicians than those who formally trained with him. From the earliest days of vitreous surgery, Robert organized courses ranging from those for beginning vitreous surgeons to others disseminating the latest sophisticated surgical techniques.
In 1978, Robert Machemer’s life took a new twist when he accepted the position of chairman of the Department of Ophthalmology at Duke University. I couldn’t believe it! I had been a resident at Bascom Palmer when he was on the faculty there and remember thinking what a loss it would be for the field of vitreoretinal diseases that this outstanding clinician, teacher, and researcher would now become an administrator!
I couldn’t have been more wrong. Robert simply marshalled his incredible vision, determination, and desire to improve things and proved that he could continue to make major contributions to vitreoretinal surgery, while guiding the Duke University Eye Center to national and international prominence. As in any department, there were bumps along the road, but Robert’s profound determination and his constant search for better ways led the Duke University Eye Center to become ranked among the top 10 ophthalmology departments in the country.
I believe that Robert Machemer will go down in history as one of the greatest—if not the greatest—contributor to the field of retinal diseases and treatment in the second half of the 20th century.
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