A Delphi method based consensus statement for surgical management of proliferative diabetic retinopathy in India

Abstract

Purpose: To derive consensus statements for surgical management of proliferative diabetic retinopathy (PDR) for vitreoretinal (VR) surgeons. Methods: Thirteen prolific VR surgeons representing all regions of India were invited to participate in a 42-point questionnaire based on the Delphi methodology describing various surgical scenarios commonly encountered in PDR. Consensus was derived using predefined robust analytics. Scenarios that returned a moderate consensus in round 1 were taken to round 2 as per the Delphi methodology. After considering all inputs, the final consensus criteria were developed. Results: A strong consensus was derived about waiting for 4 weeks before considering vitrectomy. In treatment-naïve eyes with fresh vitreous hemorrhage (VH), the wait time was slightly shorter for extramacular tractional retinal detachment (2–4 weeks) and longer (4–6 weeks) for eyes treated previously with laser or anti-VEGF agents. The expert panel recommended using preoperative anti-VEGF only in eyes with large membranes requiring extensive dissection. For post vitrectomy VH, while a conservative approach was recommended for the first episode of VH, experts recommended immediate vitreous lavage for recurrent episodes of VH. In eyes with iris neovascularization, the panel recommended immediate anti-VEGF injection followed by early vitreous lavage in nonresponsive eyes. A strong consensus was derived for stopping antiplatelet agents before surgery, while there was only a moderate consensus for performing vitrectomy for recalcitrant macular edema unresponsive to anti-VEGF injections in the absence of traction. Conclusion: This study provides valuable consensus on managing the different scenarios encountered during surgical management of PDR and should help guide the VR surgeons in clinical decision-making.

Macular hole Delphi consensus statement (MHOST)

“…The questions were divided into four categories based on the surgical time course, ranging from general vitrectomy questions, FTMH surgery questions, procedure of choice for FTMH surgery and procedure of choice for LMH surgery. To determine the amount of agreement for each scenario, a previously established approach was applied (Agrawal et al, 2021; Sengupta et al, 2021; Thein et al, 2022). In brief, the overall likelihood and agreement among experts to choose a certain decision on a given scenario were assessed in terms of percentages.…”

Late postoperative vitreous cavity hemorrhage after vitrectomy for proliferative diabetic retinopathy—observation versus intervention

“…A recent Delphi method-based consensus statement outlined that the first episode of POVCH could be managed conservatively, whereas immediate vitreous lavage for recurrent episodes was reasonable (moderate consensus). [ 11 ] Also, the practice pattern of silicone oil tamponade for preventing and managing late POVCH is not well understood. The aim of this study was to list the management preferences of late POVCH at the participating tertiary vitreoretinal surgical centers in India and analyze the treatment outcomes.…”