Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru.
Service of Ophthalmology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Eye (Lond). 2024 Jun;38(9):1722-1733. doi: 10.1038/s41433-024-03008-1. Epub 2024 Mar 11.
BACKGROUND/OBJECTIVES: To assess the methodological quality of Clinical Practice Guidelines (CPG) for the diagnosis and management of Retinal Vein Occlusion (RVO).
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.
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.
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.
背景/目的：评估视网膜静脉阻塞（RVO）诊断和管理临床实践指南（CPG）的方法学质量。
系统检索数据库、元搜索引擎、CPG 开发机构、眼科学会和 CPG 存储库中关于 RVO 诊断和管理的 CPG，检索时间截至 2022 年 4 月。2023 年 4 月进行了检索更新，未检索到新记录。选择了过去 10 年中发表的 5 篇英文/西班牙语 CPG，由 5 位作者独立使用评估指南研究与评估工具（AGREE-II）进行评估。对每个 CPG 进行领域（AGREE-II）的单独评估、对指南的总体评估以及是否修改后使用进行评估。此外，还对最相关结局的建议进行了荟萃综合。
领域 5“适用性”的得分最低（平均 18.8%），领域 4“表述清晰度”的得分最高（平均 62%）。2019 年美国指南（PPP）在领域 3“制定严谨性”方面得分最高（40.4%）。在评估分析的 CPG 的总体质量时，所有 CPG 都可以在修改后推荐使用。在荟萃综合中，抗 VEGF 治疗是与 RVO 相关黄斑水肿的首选治疗方法，但对于选择哪种类型的抗 VEGF 治疗，尚无明确建议。评估的 CPG 中，诊断和随访的建议相似。
根据 AGREE-II，大多数 RVO 诊断和管理的 CPG 方法学质量较低。PPP 在“制定严谨性”领域得分最高。在评估的 CPG 中，对于选择哪种类型的抗 VEGF 治疗，尚无明确建议。
