{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:38:35Z","timestamp":1792694315664,"version":"4.5.0"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Ophthalmology"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare 24-month visual and anatomical outcomes associated with early versus delayed switching from bevacizumab in treatment-naive eyes with center-involving diabetic macular edema (DME) and suboptimal early response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort included 87 eyes with inadequate response (&lt;5 ETDRS-letter gain and\/or &lt;20% central macular thickness [CMT] reduction) after three monthly bevacizumab injections. In a month-3 landmark analysis, eyes were classified by the month-3 treatment decision as immediate switch (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200937) or continued bevacizumab with later switching (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200950). An observed-timing comparison excluded eyes switched at months 4\u20135 (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20097) and compared early switch (month 3;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200937) with delayed switch (month \u22656;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200943) to aflibercept 2\u2005mg or ranibizumab. Outcomes from the month-3 decision point were evaluated using adjusted mixed-effects models with categorical time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At month 3, BCVA (0.42 versus 0.45 logMAR) and CMT (437 versus 408\u2005\u00b5m) were similar in the early- and delayed-switch groups. In the landmark analysis, adjusted 24-month differences were \u22120.07 logMAR (95% CI, \u22120.17 to 0.03;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20090.171), equivalent to 3.5 ETDRS letters favoring immediate switching (95% CI, \u22121.5 to 8.5), and \u221236\u2005\u00b5m (95% CI, \u221271 to \u22121;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20090.044). In the observed-timing comparison, they were \u22120.08 logMAR (4.0 letters; 95% CI, \u22121.5 to 9.5;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20090.154) and \u221239\u2005\u00b5m (95% CI, \u221277 to \u22121;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20090.044). A\u2009\u2265\u200920% CMT reduction at month 24 occurred in 62.2% versus 37.2%. Total injections numbered 11.2\u2009\u00b1\u20092.4 versus 14.5\u2009\u00b1\u20092.6.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Earlier switching was associated with greater anatomical improvement in both analyses. A 24-month visual advantage was not demonstrated, although a clinically meaningful benefit could not be excluded.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11206721261499885","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:37:23Z","timestamp":1792424243000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Visual and anatomical outcomes of early versus delayed anti-VEGF switching after bevacizumab loading in diabetic macular oedema"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7356-9826","authenticated-orcid":false,"given":"Rukiye Kilic","family":"Ucgul","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kemal","family":"Tekin","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dogukan","family":"Temel","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Furkan","family":"Karagoz","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Busra","family":"Turpcuoglu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merve","family":"Inanc Tekin","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3141-0531","authenticated-orcid":false,"given":"Kuddusi","family":"Teberik","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2011.12.039"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2018.07.030"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2204225"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1414264"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2010.02.031"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2014.2350"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-62329-9"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/8117650"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-019-0522-z"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-017-3624-y"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.5301\/ejo.5000838"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1120672118782102"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2015.12.030"},{"key":"e_1_3_2_15_2","first-page":"250","article-title":"Intravitreal aflibercept for patients with diabetic macular edema refractory to bevacizumab or ranibizumab: analysis of response to aflibercept","volume":"6","author":"Chen YY","year":"2017","unstructured":"Chen YY, Chang PY, Wang JK. Intravitreal aflibercept for patients with diabetic macular edema refractory to bevacizumab or ranibizumab: analysis of response to aflibercept. 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