PDF(Pubmed)
Abstract：
UNASSIGNED: Myopic macular degeneration (MMD) is a primary cause of blindness and visual impairment in many parts of the world. A review of clinical practice guidelines (CPGs) for intervention selection are required with the increasing demand for MMD management in clinical practice as well as in national health services. Therefore, we aim to systematically review CPGs for MMD and assist the recommendations development of the Package of Eye Care Interventions (PECI) program of the World Health Organization.
UNASSIGNED: A systematic review of CPGs published on MMD between 2010 and April 2020 was conducted. Guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Cochrane systematic reviews were also included when the evidence from included CPGs were inadequate or contradict.
UNASSIGNED: After applying exclusion criteria and conducting the quality appraisal, two CPGs were finally included. The average of the AGREE II ratings for the identified Guidelines were 56 and 63 respectively (7 for each item). To provide further information on interventions for MMD, one Cochrane review on MMD was additionally identified and included in the study. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs were recommended for patients with myopic choroidal neovascularization (mCNV) as first-line therapy to improve vision and reduce central macular thickness, and ranibizumab showed significant effectiveness compared to photodynamic therapy (PDT). PDT was recommended to be performed in those resistant to the treatment by one CPG but lacked of adequate description and support. Data extracted from the Cochrane systematic reviews indicated that anti-VEGF therapy for mCNV had significant effectiveness in improving visual acuity and reducing CMT compared to PDT with moderate to low certainty of evidence. Ranibizumab and bevacizumab were considered as equally effective with moderate certainty.
UNASSIGNED: The outcomes of this review suggest that high quality clinical practice guidelines for MMD management are limited. Intravitreal injection of anti-VEGF agents was recommended as an effective intervention to treat myopic CNV as the first-line treatment, while there was inadequate guidance for the application of PDT in myopic CNV management. The use of other interventions for MMD were not recommended at this time and additional evidence is called for.
UNASSIGNED: A systematic review of CPGs published on MMD between 2010 and April 2020 was conducted. Guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Cochrane systematic reviews were also included when the evidence from included CPGs were inadequate or contradict.
UNASSIGNED: After applying exclusion criteria and conducting the quality appraisal, two CPGs were finally included. The average of the AGREE II ratings for the identified Guidelines were 56 and 63 respectively (7 for each item). To provide further information on interventions for MMD, one Cochrane review on MMD was additionally identified and included in the study. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs were recommended for patients with myopic choroidal neovascularization (mCNV) as first-line therapy to improve vision and reduce central macular thickness, and ranibizumab showed significant effectiveness compared to photodynamic therapy (PDT). PDT was recommended to be performed in those resistant to the treatment by one CPG but lacked of adequate description and support. Data extracted from the Cochrane systematic reviews indicated that anti-VEGF therapy for mCNV had significant effectiveness in improving visual acuity and reducing CMT compared to PDT with moderate to low certainty of evidence. Ranibizumab and bevacizumab were considered as equally effective with moderate certainty.
UNASSIGNED: The outcomes of this review suggest that high quality clinical practice guidelines for MMD management are limited. Intravitreal injection of anti-VEGF agents was recommended as an effective intervention to treat myopic CNV as the first-line treatment, while there was inadequate guidance for the application of PDT in myopic CNV management. The use of other interventions for MMD were not recommended at this time and additional evidence is called for.
摘要：
未经证实：近视性黄斑变性（MMD）是世界许多地区失明和视力障碍的主要原因。随着临床实践和国家卫生服务对MMD管理的需求不断增加，需要对干预措施选择的临床实践指南（CPG）进行审查。因此,我们旨在系统地审查MMD的CPGs,并协助制定世界卫生组织眼部护理干预包(PECI)计划的建议.
UNASSIGNED：对2010年至2020年4月在MMD上发布的CPG进行了系统评价。使用评估指南II（AGREEII）工具对指南进行了评估。当包含CPG的证据不足或矛盾时，也包括Cochrane系统评价。
未经评估：应用排除标准并进行质量评估后，最终包含了两个CPG。所确定的准则的AGREEII评级的平均值分别为56和63（每个项目为7）。为了提供有关MMD干预措施的更多信息，一项Cochrane关于MMD的综述被另外确定并纳入研究.玻璃体腔注射抗血管内皮生长因子（抗VEGF）药物被推荐用于近视脉络膜新生血管（mCNV）患者作为一线治疗，以改善视力和减少黄斑中心厚度。与光动力疗法（PDT）相比，雷珠单抗显示出显着的有效性。建议在对一种CPG治疗有抵抗力的患者中进行PDT，但缺乏足够的描述和支持。从Cochrane系统评价中提取的数据表明，与PDT相比，mCNV的抗VEGF治疗在改善视力和降低CMT方面具有显着效果，证据的确定性较低。雷珠单抗和贝伐单抗被认为是同样有效的，具有中等的确定性。
UNASSIGNED：本综述的结果表明，MMD管理的高质量临床实践指南是有限的。建议玻璃体内注射抗VEGF药物作为治疗近视CNV的有效干预措施作为一线治疗，而PDT在近视CNV管理中的应用缺乏指导。目前不建议对MMD使用其他干预措施，需要额外的证据。
UNASSIGNED：对2010年至2020年4月在MMD上发布的CPG进行了系统评价。使用评估指南II（AGREEII）工具对指南进行了评估。当包含CPG的证据不足或矛盾时，也包括Cochrane系统评价。
未经评估：应用排除标准并进行质量评估后，最终包含了两个CPG。所确定的准则的AGREEII评级的平均值分别为56和63（每个项目为7）。为了提供有关MMD干预措施的更多信息，一项Cochrane关于MMD的综述被另外确定并纳入研究.玻璃体腔注射抗血管内皮生长因子（抗VEGF）药物被推荐用于近视脉络膜新生血管（mCNV）患者作为一线治疗，以改善视力和减少黄斑中心厚度。与光动力疗法（PDT）相比，雷珠单抗显示出显着的有效性。建议在对一种CPG治疗有抵抗力的患者中进行PDT，但缺乏足够的描述和支持。从Cochrane系统评价中提取的数据表明，与PDT相比，mCNV的抗VEGF治疗在改善视力和降低CMT方面具有显着效果，证据的确定性较低。雷珠单抗和贝伐单抗被认为是同样有效的，具有中等的确定性。
UNASSIGNED：本综述的结果表明，MMD管理的高质量临床实践指南是有限的。建议玻璃体内注射抗VEGF药物作为治疗近视CNV的有效干预措施作为一线治疗，而PDT在近视CNV管理中的应用缺乏指导。目前不建议对MMD使用其他干预措施，需要额外的证据。
