• Jean-François Korobelnik, Diana V Do, Ursula Schmidt-Erfurth, David S Boyer, Frank G Holz, Jeffrey S Heier, Edoardo Midena, Peter K Kaiser, Hiroko Terasaki, Dennis M Marcus, Quan D Nguyen, Glenn J Jaffe, Jason S Slakter, Christian Simader, Yuhwen Soo, Thomas Schmelter, George D Yancopoulos, Neil Stahl, Robert Vitti, Alyson J Berliner, Oliver Zeitz, Carola Metzig, and David M Brown.
• Service d'ophtalmologie, Hôpital Pellegrin-CHU de Bordeaux, Bordeaux, France; Université Bordeaux Segalen, Bordeaux, France; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France.
• Ophthalmology. 2014 Nov 1; 121 (11): 2247-54.

PurposeA head-to-head comparison was performed between vascular endothelial growth factor blockade and laser for treatment of diabetic macular edema (DME).DesignTwo similarly designed, double-masked, randomized, phase 3 trials, VISTA(DME) and VIVID(DME).ParticipantsWe included 872 patients (eyes) with type 1 or 2 diabetes mellitus who presented with DME with central involvement.MethodsEyes received either intravitreal aflibercept injection (IAI) 2 mg every 4 weeks (2q4), IAI 2 mg every 8 weeks after 5 initial monthly doses (2q8), or macular laser photocoagulation.Main Outcome MeasuresThe primary efficacy endpoint was the change from baseline in best-corrected visual acuity (BCVA) in Early Treatment Diabetic Retinopathy Study (ETDRS) letters at week 52. Secondary efficacy endpoints at week 52 included the proportion of eyes that gained ≥ 15 letters from baseline and the mean change from baseline in central retinal thickness as determined by optical coherence tomography.ResultsMean BCVA gains from baseline to week 52 in the IAI 2q4 and 2q8 groups versus the laser group were 12.5 and 10.7 versus 0.2 letters (P < 0.0001) in VISTA, and 10.5 and 10.7 versus 1.2 letters (P < 0.0001) in VIVID. The corresponding proportions of eyes gaining ≥ 15 letters were 41.6% and 31.1% versus 7.8% (P < 0.0001) in VISTA, and 32.4% and 33.3% versus 9.1% (P < 0.0001) in VIVID. Similarly, mean reductions in central retinal thickness were 185.9 and 183.1 versus 73.3 μm (P < 0.0001) in VISTA, and 195.0 and 192.4 versus 66.2 μm (P < 0.0001) in VIVID. Overall incidences of ocular and nonocular adverse events and serious adverse events, including the Anti-Platelet Trialists' Collaboration-defined arterial thromboembolic events and vascular deaths, were similar across treatment groups.ConclusionsAt week 52, IAI demonstrated significant superiority in functional and anatomic endpoints over laser, with similar efficacy in the 2q4 and 2q8 groups despite the extended dosing interval in the 2q8 group. In general, IAI was well-tolerated.Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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