Materials and Methods: A total of 120 treatment-naïve patients with DME were included. After completing three loading doses of bevacizumab, patients were divided into three groups according to the subsequent anti-vascular endothelial growth factor (anti-VEGF) treatment: Group 1 received bevacizumab (n=40), Group 2 received aflibercept (n=40), and Group 3 received ranibizumab (n=40). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were compared at baseline and at months 3, 6, and 12.

Results: All three groups demonstrated statistically significant BCVA improvement at all time points compared with baseline, whereas no significant differences were observed between the groups at any time point (p<0.001 and p=0.89, respectively). Baseline CMT values were 513.47 ± 123.97 µm, 529.82 ± 93.63 µm, and 486.63 ± 81.56 µm for Groups 1, 2, and 3, respectively; at month 12, CMT values improved to 426.21 ± 101.26 µm, 435.26 ± 84.40 µm, and 407.18 ± 83.63 µm, respectively. All groups showed significant CMT reduction from baseline (p<0.001). There was no significant difference in CMT change among the three groups at any time point (p=0.593).

Conclusion: Following bevacizumab loading, continuation with bevacizumab or switching to aflibercept or ranibizumab provides comparable functional and anatomical improvement over a 12-month follow-up period in patients with DME. Keywords : Diabetic macular edema, Treatment strategies, Anti-VEGF