Impact of Cataract Surgery on DME in VISTA and VIVID
By Jean Shaw
Selected By: Andrew P. Schachat, MD
Journal Highlights
Ophthalmology Retina, May 2020
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In a post hoc analysis of two phase 3 studies, Moshfeghi et al. set out to evaluate the impact of cataract surgery in patients who had been treated with anti-VEGF injections or laser for their diabetic macular edema (DME). They found that the incidence of cataract surgery was similar in both treatment groups—and that patients in both groups experienced improvements in best-corrected visual acuity (BCVA).
This secondary analysis was conducted in 54 patients (11 = laser treatment; 43 = intravitreal injections) who participated in the VISTA and VIVID trials and underwent cataract surgery during the initial study period. In these trials, more than 800 patients received aflibercept 2 mg every four weeks, aflibercept 2 mg every eight weeks after five monthly doses, or laser through 100 weeks.
Rescue treatment was also conducted during VISTA and VIVID, but those who received such treatment before cataract surgery were excluded from this follow-up study.
Main outcome measures for this secondary analysis were BCVA and central retinal thickness (CRT), as measured by spectral-domain optical coherence tomography. The results indicate that the cumulative incidence of cataract surgery did not depend on treatment group assignment (p = 0.2174).
With regard to pre- and post-op BCVA and CRT, at the last study visit before cataract surgery, BCVA was 62.2 letters and CRT was 342 μm in the laser control patients, versus 56.9 letters and 301 μm in the aflibercept group. At the first visit following surgery, BCVA had improved to 73.5 letters in the laser cohort and to 67.2 letters in the aflibercept patients. In contrast, CRT worsened slightly after cataract surgery, with measurements of 364 μm in the laser group and 359 μm in the aflibercept group.
The original article can be found here.