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Galvez-Olortegui J, Bouchikh-El Jarroudi R, Silva-Ocas I, Palacios-Herrera H, Cubillas-Martin M, Zavaleta-Mercado M, Burgueño-Montañes C, Galvez-Olortegui T. Systematic review of clinical practice guidelines for the diagnosis and management of retinal vein occlusion. Eye (Lond) 2024; 38:1722-1733. [PMID: 38467863 PMCID: PMC11156943 DOI: 10.1038/s41433-024-03008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/08/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
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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Affiliation(s)
- Jose Galvez-Olortegui
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru.
- Service of Ophthalmology, Hospital Universitario Central de Asturias, Oviedo, Spain.
- Universidad Nacional de Tumbes, Tumbes, Peru.
| | - Rachid Bouchikh-El Jarroudi
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Service of Ophthalmology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Surgery, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Isabel Silva-Ocas
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Centro de Excelencia en Glaucoma, Clinica GO-Vision, Lima, Peru
| | - Hector Palacios-Herrera
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Servicio de Retina y Vitreo, EP Oftalmólogos asociados, Lima, Peru
| | | | - Miguel Zavaleta-Mercado
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Instituto de Investigaciones Oftalmológicas y Ciencias Visuales Avanzadas Zavaleta Mercado (Innovaz), Oruro, Bolivia
| | - Carmen Burgueño-Montañes
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Service of Ophthalmology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Tomas Galvez-Olortegui
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
- Centro de Excelencia en Glaucoma, Clinica GO-Vision, Lima, Peru
- Department of Ophthalmology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
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Gao D, Da Z, Yang K, Shi Y. Comparison of seven cyclosporine A formulations for dry eye disease: A systematic review and network meta-analysis. Front Pharmacol 2022; 13:882803. [PMID: 36419623 PMCID: PMC9676501 DOI: 10.3389/fphar.2022.882803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/20/2022] [Indexed: 08/27/2023] Open
Abstract
Background: Dry eye disease is a common ocular surface disease affecting tens of millions of people worldwide. It is characterized by an unstable tear film and increasing prevalence. Different commercial formulations of cyclosporine A for dry eye have been approved, however, it is still unclear whether the differences in formulations of these products will make a difference in clinical efficacy and safety. Methods: Randomized controlled trials of commercial cyclosporine A formulation for dry eye disease were searched in Pubmed, EMBASE, Scopus, and Cochrane controlled trials registries and Web of Science from inception till 1 December 2021. Independent literature screening, data extraction, quality evaluation, and the study in line with quality standards were analyzed by using Stata16.0 software. The study is registered with PROSPERO under the number CRD42022301423. Code and data for this study is publicly available (https://github.com/DongYangGao/Dongyang.github.io.git). Results: 21 randomized clinical trials with a total of 4,107 participants were included in this study. Restasis® (OR-4.82, 95% CI-6.18 to 3.45, SUCRA 77.2%) was the most effective commercial formulation for reducing OSDI, Zirun® (SUCRA 73.9%) performed better in improving Schirmer's test. TJ Cyporin® (SUCRA 65.3%) ranked first in terms of improving tear film break-up time. For treatment-emergent adverse events incidence, Clacier® was close to placebo. The risk of reporting bias is considered low. Conclusion: In the comparison of outcomes included in this study, the optimal order of various commercial cyclosporine A formulations is different, so it is difficult to select the optimal formula. Appropriate commercial formulations should be selected according to patients' conditions in clinical practice.
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Affiliation(s)
- Dongyang Gao
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Zhuoli Da
- Department of Ophthalmology, The First People’s Hospital of Lanzhou City, Lanzhou, China
| | - Kan Yang
- Department of Ophthalmology, The First People’s Hospital of Lanzhou City, Lanzhou, China
| | - Yuanyuan Shi
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
- Shenzhen Research Institute, Beijing University of Chinese Medicine, Shenzhen, China
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