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Intravitreal antivascular endothelial growth factor in diabetic macular oedema: scoping review of clinical practice guidelines recommendations
  1. Manuel Vargas-Peirano1,2,3,
  2. Catalina Verdejo3,
  3. Laura Vergara-Merino1,3,
  4. Cristóbal Loézar1,3,4,
  5. Martin Hoehmann3,5,
  6. Javier Pérez-Bracchiglione1,3
  1. 1 Interdisciplinary Center for Health Studies (CIESAL), Universidad de Valparaiso, Vina del Mar, Chile
  2. 2 Ophthalmology Service, Hospital Mario Sanchez Vergara, La Calera, Chile
  3. 3 School of Medicine, Universidad de Valparaiso, Vina del Mar, Chile
  4. 4 Ophthalmology Service, Hospital Naval Almirante Nef, Viña del Mar, Chile
  5. 5 Ophthalmology Service, Hospital Carlos Van Buren, Valparaiso, Chile
  1. Correspondence to Dr Manuel Vargas-Peirano, Interdisciplinary Center for Health Studies CIESAL, Facultad de Medicina, Universidad de Valparaiso, Vina del Mar, Chile; manuel.vargas{at}


Background Diabetic macular oedema (DME) is a worldwide major cause of low vision and blindness. Intravitreal antivascular endothelial growth factor (anti-VEGF) constitutes an effective treatment. Clinical practice guidelines (CPGs) are synthesis documents that seek to improve patient care.

Objectives To identify CPGs that make anti-VEGF recommendations for DME and to assess their reporting quality and their considerations when making recommendations.

Eligibility criteria CPGs published between December 2009 and December 2019 that make explicit anti-VEGF recommendations in DME.

Sources of evidence Sensitive search strategy in Embase, Google Scholar and hand-searching on 165 websites.

Methods We extracted information from each CPG with a previously piloted sheet. Two independent authors applied theAppraisal of Guidelines, Research and Evaluation tool (AGREE-II) assessment for each CPG.

Results The 21 included CPGs recommend anti-VEGF for DME, but there is a wide variation among the clinical aspects included, such as location of DME, visual acuity required, therapeutical alternatives or discontinuation. Most have a poor quality of reporting based on the AGREE-II tool assessment, especially those developed by ophthalmological societies, those that have an exclusive content about DME, and those where most of their authors disclose conflict of interest (COI) with pharmaceutical industry or where their authors did not report COIs. Pharmaceutical-sponsored CPGs did not use systematic reviews (SRs) to support their recommendations. Very few recommendations consider patient values and preferences, equity, acceptability and feasibility of the intervention.

Conclusions Most of the CPGs that made recommendations of anti-VEGF for DME have poor quality of reporting, do not use SRs and do not consider patients’ values and preferences.

  • macula
  • treatment other
  • epidemiology
  • drugs
  • retina

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  • Contributors MV-P, CV, LV-M, CL and JP-B designed the scoping review. MV-P wrote the search strategy and the statistical analysis plan, analysed the data, and drafted and revised the paper. He is the guarantor. CV, LV-M and CL drafted and revised the paper. JP-B wrote the search strategy and drafted and revised the paper. MH interpreted the data and drafted and revised the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.