Journal of Ophthalmic & Vision Research (Jan 2018)

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

  • Homayoun Nikkhah,
  • Saeed Karimi,
  • Hamid Ahmadieh,
  • Mohsen Azarmina,
  • Majid Abrishami,
  • Hossein Ahoor,
  • Yousef Alizadeh,
  • Hasan Behboudi,
  • Narsis Daftarian,
  • Mohammad Hossein Dehghan,
  • Morteza Entezari,
  • Fereydoun Farrahi,
  • Heshmatollah Ghanbari,
  • Khalil Ghasemi Falavarjani,
  • Mohammad Ali Javadi,
  • Reza Karkhaneh,
  • Siamak Moradian,
  • Masoud Reza Manaviat,
  • Morsal Mehryar,
  • Ramin Nourinia,
  • Mohammad Mehdi Parvaresh,
  • Alireza Ramezani,
  • Alireza Ragati Haghi,
  • Mohammad Riazi-Esfahani,
  • Masoud Soheilian,
  • Mohsen Shahsavari,
  • Hossein-Ali Shahriari,
  • Zhale Rajavi,
  • Sare Safi,
  • Armin Shirvani,
  • Saeed Rahmani,
  • Hamideh Sabbaghi,
  • Mojgan Pakbin,
  • Bahareh Kheiri,
  • Hossein Ziaei

DOI
https://doi.org/10.4103/jovr.jovr_50_18
Journal volume & issue
Vol. 13, no. 2
pp. 158 – 169

Abstract

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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.

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