ABSTRACT
BACKGROUND/OBJECTIVES: To assess the methodological quality of Clinical Practice Guidelines (CPG) for the diagnosis and management of Retinal Vein Occlusion (RVO). METHODS: A systematic review of CPGs for the diagnosis and management of RVO was carried out with a search in databases, metasearch engines, CPG development institutions, ophthalmology associations and CPG repositories until April 2022. Search update was performed on April 2023, with no new record available. Five CPGs published in the last 10 years in English/Spanish were selected, and 5 authors evaluated them independently, using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument. An individual assessment of each CPG by domain (AGREE-II), an overall assessment of the guide, and its use with or without modifications were performed. Additionally, a meta-synthesis of the recommendations for the most relevant outcomes was carried out. RESULTS: The lowest score (mean 18.8%) was for domain 5 'applicability', and the highest score (mean 62%) was for domain 4 'clarity of presentation'. The 2019 American guideline (PPP) presented the best score (40.4%) in domain 3 'rigour of development'. When evaluating the overall quality of the CPGs analysed, all CPGs could be recommended with modifications. In the meta-synthesis, anti-VEGF therapy is the first-choice therapy for macular oedema associated with RVO, but there is no clear recommendation about the type of anti-VEGF therapy to choose. Recommendations for diagnosis and follow-up are similar among the CPGs appraised. CONCLUSION: Most CPGs for the diagnosis and management of RVO have a low methodological quality assessed according to the AGREE-II. PPP has the higher score in the domain 'rigour of development'. Among the CPGs appraised, there is no clear recommendation on the type of anti-VEGF therapy to choose.
Subject(s)
Angiogenesis Inhibitors , Practice Guidelines as Topic , Retinal Vein Occlusion , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/therapy , Humans , Angiogenesis Inhibitors/therapeutic use , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Intravitreal Injections , Disease Management , Ophthalmology/standardsABSTRACT
Objetivo: Demostrar los hallazgos angiográficos en pacientes con retinopatía diabética (RD). Materiales y métodos: estudio descriptivo, retrospectivo realizado en el servicio de Oftalmología del HNERM, durante el período Julio - Diciembre del 2001. Durante este período se realizaron 432 angiofluoresceinografías (AFG), se revisaron 285 obteniéndose 114 diagnósticos angiográficos de RD. Resultados: retinopatía diabética no proliferativa (RDNP) leve 23 ojos (20,1 por ciento), RDNP moderada 18 ojos (15,7 por ciento), RDNP severa 47 ojos (41,2 por ciento), RD proliferativa 13 ojos (11,5 por ciento) y maculopatía diabética 13 ojos (11,5 por ciento). Discusión: La Academia Americana de Oftalmología tiene usualmente las siguientes indicaciones específicas en la RD para solicitar AGF: guía para establecer el patrón de tratamiento en EMCS, evaluar una pérdida visual inespecífica, determinar las zonas de no perfusión y diferenciar los neovasos de la IRMA. Conclusiones: RDNP severa y R. D proliferativa alcanzan más del 50 por ciento en nuestra población.
