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

Abstract

Background/Objectives: To assess the 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, published between January-2010 and April-2022, was carried out with a search in databases, metasearch engines, CPG development institutions, ophthalmology associations and CPG repositories.CPGs 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 was performed. Additionally, a meta-synthesis of the recommendations for the most relevant outcomes was carried out. Results: 5/6 CPGs scored low in domain 3(rigour of development), and the highest score(mean 62%) was for domain 4(clarity of presentation). 2019 American guideline (PPP) presented the best score(40.4%) in domain 3. When evaluating the overall quality of the CPGs analyzed, all CPGs could be recommended with modifications. In the meta-synthesis, anti-VEGF therapy is the first-choice therapy for macular edema 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 CPGs evaluated. Conclusion: Most CPGs for the diagnosis and management of retinal vein occlusion have a low methodological quality evaluated according to the AGREE-II. PPP has the higher score in the domain “Rigour of Development”. Among the CPGs evaluated, there is no clear recommendation on the type of anti-VEGF therapy to choose.