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Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion

Eye volume 38, pages 1722–1733 (2024)Cite this article

Subjects

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.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru

    Jose Galvez-Olortegui, Rachid Bouchikh-El Jarroudi, Isabel Silva-Ocas, Hector Palacios-Herrera, Miguel Zavaleta-Mercado, Carmen Burgueño-Montañes & Tomas Galvez-Olortegui

  2. Service of Ophthalmology, Hospital Universitario Central de Asturias, Oviedo, Spain

    Jose Galvez-Olortegui, Marta Cubillas-Martin & Carmen Burgueño-Montañes

  3. Universidad Nacional de Tumbes, Tumbes, Peru

    Jose Galvez-Olortegui

  4. Service of Ophthalmology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain

    Rachid Bouchikh-El Jarroudi

  5. Department of Surgery, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain

    Rachid Bouchikh-El Jarroudi

  6. Centro de Excelencia en Glaucoma, Clinica GO-Vision, Lima, Peru

    Isabel Silva-Ocas & Tomas Galvez-Olortegui

  7. Servicio de Retina y Vitreo, EP Oftalmólogos asociados, Lima, Peru

    Hector Palacios-Herrera

  8. Instituto de Investigaciones Oftalmológicas y Ciencias Visuales Avanzadas Zavaleta Mercado (Innovaz), Oruro, Bolivia

    Miguel Zavaleta-Mercado

  9. Department of Ophthalmology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru

    Tomas Galvez-Olortegui

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Contributions

JGO: Conceptualisation, Validation, Formal analysis, Investigation, Data Curation, Writing - Original Draft, Writing - Review & Editing. RBE: Validation, Formal analysis, Investigation, Data Curation, Writing - Original Draft, Writing - Review & Editing. ISO: Validation, Formal analysis, Investigation, Data Curation, Writing - Review & Editing. HPH: Validation, Formal analysis, Investigation, Data Curation, Writing - Review & Editing. MCM: Conceptualisation, Writing - Review & Editing. CBM: Validation, Investigation, Data Curation, Writing - Review & Editing. TGO: Conceptualisation, Investigation, Writing - Review & Editing.

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Correspondence to Jose Galvez-Olortegui.

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Competing interests

JGO was peer reviewer of CPG, CPG critical appraisal tools, and SR of CPG, for Annals of Internal Medicine, Journal of Evidence Based Medicine and Journal of Affective Disorders. JGO has received speaker fees from Novelty Technology Care and Angelini. JGO has received Travel and meeting support from Esteve, Bausch and Lomb, Thea, Equipsa, Alcon, Zeiss, Angelini. RBE has received Travel and meeting support from Novartis Spain, Angelini, Thea, Roche, Alcon, Esteve and AbbVie. CBM has received Travel and meeting support from Bausch. ISO, HPH, MCM, MZM and TGO have nothing to disclose.

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Galvez-Olortegui, J., Bouchikh-El Jarroudi, R., Silva-Ocas, I. et al. Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion. Eye 38, 1722–1733 (2024). https://doi.org/10.1038/s41433-024-03008-1

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