Intravitreal injection of anti-vascular endothelial growth factor agents for ocular vascular diseases: Clinical practice guideline

Nikkhah, H. and Karimi, S. and Ahmadieh, H. and Azarmina, M. and Abrishami, M. and Ahoor, H. and Alizadeh, Y. and Behboudi, H. and Daftarian, N. and Dehghan, M. and Entezari, M. and Farrahi, F. and Ghanbari, H. and Falavarjani, K. and Javadi, M.A. and Karkhaneh, R. and Moradian, S. and Manaviat, M.R. and Mehryar, M. and Nourinia, R. and Parvaresh, M.M. and Ramezani, A. and Haghi, A.R. and Riazi-Esfahani, M. and Soheilian, M. and Shahsavari, M. and Shahriari, H.-A. and Rajavi, Z. and Safi, S. and Shirvani, A. and Rahmani, S. and Sabbaghi, H. and Pakbin, M. and Kheiri, B. and Ziaei, H. (2018) Intravitreal injection of anti-vascular endothelial growth factor agents for ocular vascular diseases: Clinical practice guideline. Journal of Ophthalmic and Vision Research, 13 (2). pp. 158-169.

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Abstract

Purpose: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. Methods: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. Results: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. Conclusion: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients. © 2018 Journal of Ophthalmic and Vision Research.

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