{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:53:51Z","timestamp":1793393631251,"version":"4.5.0"},"reference-count":77,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,7,20]],"date-time":"2024-07-20T00:00:00Z","timestamp":1721433600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2024,6,30]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>Treatment decisions for neovascular age-related macular degeneration (nAMD) in the setting of individualised treatment regimens are adapted to disease activity. The main marker of disease activity and trigger for re-treatment with anti-vascular endothelial growth factor (anti-VEGF) agents is the presence of retinal fluid on optical coherence tomography (OCT). Recently, attention has focused on the impact of residual retinal fluid on nAMD management. Based on a literature review and the combined clinical experience of an international group of retinal specialists, this manuscript provides expert guidance on the treatment of nAMD according to fluid status and proposes an algorithm for determining when to administer anti-VEGF treatment according to residual fluid status. We explore the role of residual fluid in treatment decisions and outcomes in nAMD, taking into consideration fluid evaluation and, in particular, distinguishing between fluid in different anatomic compartments and at different stages during the treatment course. Current limitations to identifying and interpreting fluid on OCT, and the assumption that any residual retinal fluid reflects ongoing VEGF activity, are discussed.<\/jats:p>","DOI":"10.1136\/bjo-2024-325640","type":"journal-article","created":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T08:33:04Z","timestamp":1721637184000},"page":"307-315","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of residual retinal fluid on treatment outcomes in neovascular age-related macular degeneration"],"prefix":"10.1136","volume":"109","clinical-trial-number":[{"clinical-trial-number":"nct05476926","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1147-444X","authenticated-orcid":false,"given":"Dinah","family":"Zur","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn","family":"Guymer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4438-9535","authenticated-orcid":false,"given":"Jean-Fran\u00e7ois","family":"Korobelnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihteh","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1208-913X","authenticated-orcid":false,"given":"Francesco","family":"Viola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5617-346X","authenticated-orcid":false,"given":"Nicole","family":"Eter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1700-8570","authenticated-orcid":false,"given":"St\u00e9phanie","family":"Baillif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youxin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer J","family":"Arnold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,7,20]]},"reference":[{"key":"2025040422450975000_109.3.307.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa062655"},{"key":"2025040422450975000_109.3.307.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa054481"},{"key":"2025040422450975000_109.3.307.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2012.09.006"},{"key":"2025040422450975000_109.3.307.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1102673"},{"key":"2025040422450975000_109.3.307.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2019.04.017"},{"key":"2025040422450975000_109.3.307.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2012.10.014"},{"key":"2025040422450975000_109.3.307.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61501-9"},{"key":"2025040422450975000_109.3.307.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2015.08.009"},{"key":"2025040422450975000_109.3.307.9","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1097\/IAE.0000000000000166","article-title":"Subretinal hyperreflective exudation associated with neovascular age-related macular degeneration","volume":"34","author":"Shah","year":"2014","journal-title":"Retina"},{"key":"2025040422450975000_109.3.307.10","doi-asserted-by":"crossref","first-page":"2249","DOI":"10.1038\/s41433-020-0799-y","article-title":"Association between visual acuity, lesion activity markers and retreatment decisions in neovascular age-related macular degeneration","volume":"34","author":"Chakravarthy","year":"2020","journal-title":"Eye (Lond)"},{"key":"2025040422450975000_109.3.307.11","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0000000000000645"},{"key":"2025040422450975000_109.3.307.12","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1038\/eye.2015.48","article-title":"Defining response to anti-VEGF therapies in neovascular AMD","volume":"29","author":"Amoaku","year":"2015","journal-title":"Eye (Lond)"},{"key":"2025040422450975000_109.3.307.13","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2014-305702"},{"key":"2025040422450975000_109.3.307.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2012.04.015"},{"key":"2025040422450975000_109.3.307.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12886-016-0207-3","article-title":"The role of sub-retinal fluid in determining treatment outcomes in patients with neovascular age-related macular degeneration - a phase IV randomised clinical trial with ranibizumab: the FLUID study","volume":"16","author":"Arnold","year":"2016","journal-title":"BMC Ophthalmol"},{"key":"2025040422450975000_109.3.307.16","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/j.oret.2018.01.005","article-title":"Interpretation of subretinal fluid using OCT in intermediate age-related macular degeneration","volume":"2","author":"Lek","year":"2018","journal-title":"Ophthalmol Retina"},{"key":"2025040422450975000_109.3.307.17","unstructured":"Hahn P , Eliott D , eds. 2021 global trends in retina survey. 2021. Available: https:\/\/www.asrs.org\/content\/documents\/2021-global-trends-survey-highlights.pdf"},{"key":"2025040422450975000_109.3.307.18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ophtha.2019.09.024","article-title":"Age-related macular degeneration preferred practice pattern\u00ae","volume":"127","author":"Flaxel","year":"2020","journal-title":"Ophthalmology"},{"key":"2025040422450975000_109.3.307.19","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1038\/eye.2013.233","article-title":"The royal college of ophthalmologists guidelines on AMD: executive summary","volume":"27","author":"Chakravarthy","year":"2013","journal-title":"Eye (Lond)"},{"key":"2025040422450975000_109.3.307.20","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1016\/j.ophtha.2016.03.037","article-title":"Morphology and visual acuity in aflibercept and ranibizumab therapy for neovascular age-related macular degeneration in the VIEW trials","volume":"123","author":"Waldstein","year":"2016","journal-title":"Ophthalmology"},{"key":"2025040422450975000_109.3.307.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2013.12.029"},{"key":"2025040422450975000_109.3.307.22","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1097\/IAE.0000000000002270","article-title":"Underdiagnosed optic disk pit maculopathy: spectral domain optical coherence tomography features for accurate diagnosis","volume":"39","author":"Iglicki","year":"2019","journal-title":"Retina (Philadelphia, Pa)"},{"key":"2025040422450975000_109.3.307.23","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2020-317326"},{"key":"2025040422450975000_109.3.307.24","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0000000000003023"},{"key":"2025040422450975000_109.3.307.25","doi-asserted-by":"crossref","first-page":"4039","DOI":"10.1167\/iovs.16-20201","article-title":"Spatial correspondence between intraretinal fluid, subretinal fluid, and pigment epithelial detachment in neovascular age-related macular degeneration","volume":"58","author":"Klimscha","year":"2017","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2025040422450975000_109.3.307.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2018.11.025"},{"key":"2025040422450975000_109.3.307.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2016.04.005"},{"key":"2025040422450975000_109.3.307.28","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.ophtha.2017.10.031","article-title":"Fully automated detection and quantification of macular fluid in OCT using deep learning","volume":"125","author":"Schlegl","year":"2018","journal-title":"Ophthalmology"},{"key":"2025040422450975000_109.3.307.29","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1111\/aos.13565","article-title":"Age-related macular degeneration: using morphological predictors to modify current treatment protocols","volume":"96","author":"Ashraf","year":"2018","journal-title":"Acta Ophthalmol"},{"key":"2025040422450975000_109.3.307.30","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2014-305186"},{"key":"2025040422450975000_109.3.307.31","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ophtha.2015.09.013","article-title":"Predictive value of retinal morphology for visual acuity outcomes of different ranibizumab treatment regimens for neovascular AMD","volume":"123","author":"Waldstein","year":"2016","journal-title":"Ophthalmology"},{"key":"2025040422450975000_109.3.307.32","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.oret.2017.10.003","article-title":"Baseline predictors for five-year visual acuity outcomes in the comparison of AMD treatment trials","volume":"2","author":"Ying","year":"2018","journal-title":"Ophthalmol Retina"},{"key":"2025040422450975000_109.3.307.33","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-018-36704-6","article-title":"Biomarkers of optical coherence tomography in evaluating the treatment outcomes of neovascular age-related macular degeneration: a real-world study","volume":"9","author":"Lai","year":"2019","journal-title":"Sci Rep"},{"key":"2025040422450975000_109.3.307.34","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/j.ophtha.2014.11.017","article-title":"Pigment epithelial detachment followed by retinal cystoid degeneration leads to vision loss in treatment of neovascular age-related macular degeneration","volume":"122","author":"Schmidt-Erfurth","year":"2015","journal-title":"Ophthalmology"},{"key":"2025040422450975000_109.3.307.35","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1159\/000430103","article-title":"The presence of Intra- or subretinal fluid during the loading phase in the treatment of exudative age-related macular degeneration with intravitreal ranibizumab assessed by optical coherence tomography","volume":"234","author":"Ebneter","year":"2015","journal-title":"Ophthalmologica"},{"key":"2025040422450975000_109.3.307.36","doi-asserted-by":"publisher","DOI":"10.1016\/J.OPHTHA.2020.09.025"},{"key":"2025040422450975000_109.3.307.37","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.oret.2021.12.007","article-title":"Impact of Intra- and subretinal fluid on vision based on volume quantification in the HARBOR trial","volume":"6","author":"Riedl","year":"2022","journal-title":"Ophthalmol Retina"},{"key":"2025040422450975000_109.3.307.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2015.12.002"},{"key":"2025040422450975000_109.3.307.39","doi-asserted-by":"crossref","first-page":"1856","DOI":"10.1016\/j.ophtha.2016.05.016","article-title":"Differential response to anti-VEGF regimens in age-related macular degeneration patients with early persistent retinal fluid","volume":"123","author":"Jaffe","year":"2016","journal-title":"Ophthalmology"},{"key":"2025040422450975000_109.3.307.40","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1097\/IAE.0000000000002910","article-title":"Assessment of early changes in spectral domain-optical coherence tomography after initiation of treatment with intravitreal aflibercept (Eylea) over a 12-week period for patients with neovascular age-related macular degeneration: a multicenter French study (START)","volume":"41","author":"Korobelnik","year":"2021","journal-title":"Retina (Philadelphia, Pa)"},{"key":"2025040422450975000_109.3.307.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2020.03.010"},{"key":"2025040422450975000_109.3.307.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2016.03.045"},{"key":"2025040422450975000_109.3.307.43","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.oret.2022.03.024","article-title":"Predominantly persistent Intraretinal fluid in the comparison of age-related macular degeneration treatments trials","volume":"6","author":"Core","year":"2022","journal-title":"Ophthalmol Retina"},{"key":"2025040422450975000_109.3.307.44","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.oret.2021.06.003","article-title":"Predominantly persistent subretinal fluid in the comparison of age-related macular degeneration treatments trials","volume":"5","author":"Core","year":"2021","journal-title":"Ophthalmol Retina"},{"key":"2025040422450975000_109.3.307.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2013.03.046"},{"key":"2025040422450975000_109.3.307.46","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1097\/IAE.0000000000000902","article-title":"Implication of recurrent or retained fluid on optical coherence tomography for visual acuity during active treatment of neovascular age-related macular degeneration with a treat and extend protocol","volume":"36","author":"Wickremasinghe","year":"2016","journal-title":"Retina"},{"key":"2025040422450975000_109.3.307.47","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ajo.2021.06.029","article-title":"Effect of residual retinal fluid on visual function in ranibizumab-treated neovascular age-related macular degeneration","volume":"233","author":"Holekamp","year":"2022","journal-title":"Am J Ophthalmol"},{"key":"2025040422450975000_109.3.307.48","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1097\/IAE.0000000000000465","article-title":"Refractory Intraretinal or subretinal fluid in neovascular age-related macular degeneration treated with intravitreal ranizubimab: functional and structural outcome","volume":"35","author":"Gianniou","year":"2015","journal-title":"Retina (Philadelphia, Pa)"},{"key":"2025040422450975000_109.3.307.49","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2018.08.035"},{"key":"2025040422450975000_109.3.307.50","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-020-01354-4"},{"key":"2025040422450975000_109.3.307.51","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1097\/IAE.0000000000003699","article-title":"Impact of retinal fluid-free months on outcomes in neovascular age-related macular degeneration: a treatment agnostic analysis of the HAWK and HARRIER studies","volume":"43","author":"Eichenbaum","year":"2023","journal-title":"Retina"},{"key":"2025040422450975000_109.3.307.52","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-022-02077-4"},{"key":"2025040422450975000_109.3.307.53","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/j.ajo.2015.01.032","article-title":"Macular atrophy progression and 7-year vision outcomes in subjects from the ANCHOR, MARINA, and HORIZON studies: the SEVEN-UP study","volume":"159","author":"Bhisitkul","year":"2015","journal-title":"Am J Ophthalmol"},{"key":"2025040422450975000_109.3.307.54","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2017.12.026"},{"key":"2025040422450975000_109.3.307.55","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2013.08.015"},{"key":"2025040422450975000_109.3.307.56","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2016.09.012"},{"key":"2025040422450975000_109.3.307.57","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ophtha.2018.07.013","article-title":"Intralesional macular atrophy in anti-vascular endothelial growth factor therapy for age-related macular degeneration in the IVAN trial","volume":"126","author":"Bailey","year":"2019","journal-title":"Ophthalmology"},{"key":"2025040422450975000_109.3.307.58","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0000000000002717"},{"key":"2025040422450975000_109.3.307.59","doi-asserted-by":"crossref","first-page":"8036","DOI":"10.1038\/s41598-020-64901-9","article-title":"Impact of sub-retinal fluid on the long-term incidence of macular atrophy in neovascular age-related macular degeneration under treat & extend anti-vascular endothelial growth factor inhibitors","volume":"10","author":"Siedlecki","year":"2020","journal-title":"Sci Rep"},{"key":"2025040422450975000_109.3.307.60","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.1038\/s41433-020-0764-9","article-title":"Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration","volume":"34","author":"Chandra","year":"2020","journal-title":"Eye (Lond)"},{"key":"2025040422450975000_109.3.307.61","doi-asserted-by":"crossref","first-page":"907","DOI":"10.3928\/23258160-20151008-02","article-title":"Optical coherence tomography angiography reveals mature, tangled vascular networks in eyes with neovascular age-related macular degeneration showing resistance to geographic atrophy","volume":"46","author":"Dansingani","year":"2015","journal-title":"Ophthalmic Surg Lasers Imaging Retina"},{"key":"2025040422450975000_109.3.307.62","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2013.11.031"},{"key":"2025040422450975000_109.3.307.63","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.oret.2018.01.006","article-title":"Real-world outcomes of anti-vascular endothelial growth factor therapy in neovascular age-related macular degeneration in the United States","volume":"2","author":"Ciulla","year":"2018","journal-title":"Ophthalmol Retina"},{"key":"2025040422450975000_109.3.307.64","doi-asserted-by":"publisher","DOI":"10.1016\/j.oret.2019.05.017"},{"key":"2025040422450975000_109.3.307.65","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2015-308166"},{"key":"2025040422450975000_109.3.307.66","doi-asserted-by":"crossref","first-page":"3351","DOI":"10.1038\/s41433-023-02540-w","article-title":"Save our Sight (SOS): a collective call-to-action for enhanced retinal care across health systems in high income countries","volume":"37","author":"Loewenstein","year":"2023","journal-title":"Eye (Lond)"},{"key":"2025040422450975000_109.3.307.67","doi-asserted-by":"publisher","DOI":"10.1159\/000502747"},{"key":"2025040422450975000_109.3.307.68","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1038\/eye.2017.67","article-title":"A systematic review to assess the 'treat-and-extend' dosing regimen for neovascular age-related macular degeneration using ranibizumab","volume":"31","author":"Rufai","year":"2017","journal-title":"Eye (Lond)"},{"key":"2025040422450975000_109.3.307.69","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1097\/IAE.0000000000000627","article-title":"Treat-and-extend regimens with anti-VEGF agents in retinal diseases: a literature review and consensus recommendations","volume":"35","author":"Freund","year":"2015","journal-title":"Retina"},{"key":"2025040422450975000_109.3.307.70","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2010.02.019"},{"key":"2025040422450975000_109.3.307.71","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2017.09.028"},{"key":"2025040422450975000_109.3.307.72","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.ophtha.2019.09.035","article-title":"Incomplete retinal pigment epithelial and outer retinal atrophy in age-related macular degeneration: classification of atrophy meeting Report 4","volume":"127","author":"Guymer","year":"2020","journal-title":"Ophthalmology"},{"key":"2025040422450975000_109.3.307.73","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0000000000000471"},{"key":"2025040422450975000_109.3.307.74","doi-asserted-by":"publisher","DOI":"10.1001\/archophthalmol.2009.326"},{"key":"2025040422450975000_109.3.307.75","doi-asserted-by":"crossref","DOI":"10.1016\/j.xops.2021.100076","article-title":"TENAYA and LUCERNE: rationale and design for the phase 3 clinical trials of faricimab for neovascular age-related macular degeneration","volume":"1","author":"Khanani","year":"2021","journal-title":"Ophthalmol Sci"},{"key":"2025040422450975000_109.3.307.76","doi-asserted-by":"crossref","DOI":"10.1016\/j.xops.2023.100442","article-title":"Rationale and design of VOYAGER: long-term outcomes of faricimab and port delivery system with ranibizumab for neovascular age-related macular degeneration and diabetic macular edema in clinical practice","volume":"4","author":"Guymer","year":"2024","journal-title":"Ophthalmol Sci"},{"key":"2025040422450975000_109.3.307.77","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.13-11665"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2024-325640","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T09:29:50Z","timestamp":1743845390000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2024-325640"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,20]]},"references-count":77,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2,24]]},"published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1136\/bjo-2024-325640"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2024-325640","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,20]]}}}