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Andrew A Moshfeghi; Impact of Cataract Surgery on Visual and Anatomic Outcomes in Patients treated for Diabetic Macular Edema (DME) in the VISTA and VIVID Trials.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1907.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effect of cataract surgery on visual and anatomic outcomes in patients with DME treated with intravitreal aflibercept injection (IAI) or laser in VISTA and VIVID
VISTA and VIVID, two similarly designed phase 3 trials, treated 461 and 404 DME patients, respectively, with IAI 2 mg q4 weeks (2q4), IAI 2 mg q8 weeks following 5 monthly doses (2q8), or laser through week 100. Starting at week 24, if rescue treatment criteria were met, IAI patients received laser, and laser patients received IAI 2q8 (following 5 monthly doses). Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were assessed monthly for two years. A post-hoc analysis evaluated the impact of cataract surgery on BCVA and CRT in the laser and combined IAI groups. Patients were censored from the analysis at the time of rescue treatment.
Cataract surgeries were performed in the study eye of 20 and 48 laser and IAI patients, respectively. The corresponding numbers after censoring patients at time of rescue therapy were 11 and 43 surgeries. At the first study visit post-op, the mean BCVA gains from the last visit pre-op was 11.3 letters (62.2 vs 73.5 letters) for laser patients and 10.7 letters (56.5 vs 67.2 letters) for IAI patients. The corresponding gains at the first study visit at least 30 days post-op were 10.1 letters (72.0 vs 61.9 letters) for laser patients and 13.2 letters (69.5 vs 56.3 letters) for IAI patients. At the first study visit post-op, the mean CRT changes from the last visit pre-op was +22.5 µm (341.6 vs 364.1µm) for laser patients and +58.0 µm (301.3 vs 359.3 µm) for IAI patients. The corresponding changes at the first study visit at least 30 days post-op were +36.9 µm (388.4 vs 351.5µm) for laser patients and +63.8µm (365.7 vs 301.9 µm) for IAI patients.
Overall, visual gains were observed in patients treated with laser or IAI following cataract surgery. Despite a modest worsening in CRT after cataract surgery, BCVA gains trended higher for patients being treated with IAI as compared to laser in this short-term post-hoc analysis.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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