Customized Clinical Practice Guidelines for Management of Adult Cataract in Iran.

Sare Safi,Hossein Mohammad-Rabei,Hamid Ahmadieh,Zhaleh Rajavi,Narsis Daftarian,Nader Nassiri,Hossein Ziaei,Armin Shirvani,Mahmoud Jabbarvand,Sepehr Feizi,Mahmoodreza Panahi-Bazaz,Mehrdad Mohammadpour,Kourosh Sheibani,Saeid Shahraz,Farid Karimian,Hassan Hashemi,Farhad Nejat,Mohammad Reza Rohani ,Mohammad Ali Javadi ,Ali Foroutan ,Mohammad Reza Sedaghat ,Hamid-Reza Moein ,Behzad Fallahi Motlagh ,M R Jafarinasab ,Seyed Javad Hashemian

doi:10.4103/2008-322x.176913

Abstract

Purpose:To customize clinical practice guidelines (CPGs) for cataract management in the Iranian population.Methods:First, four CPGs (American Academy of Ophthalmology 2006 and 2011, Royal College of Ophthalmologists 2010, and Canadian Ophthalmological Society 2008) were selected from a number of available CPGs in the literature for cataract management. All recommendations of these guidelines, together with their references, were studied. Each recommendation was summarized in 4 tables. The first table showed the recommendation itself in clinical question components format along with its level of evidence. The second table contained structured abstracts of supporting articles related to the clinical question with their levels of evidence. The third table included the customized recommendation of the internal group respecting its clinical advantage, cost, and complications. In the fourth table, the internal group their recommendations from 1 to 9 based on the customizing capability of the recommendation (applicability, acceptability, external validity). Finally, customized recommendations were sent one month prior to a consensus session to faculty members of all universities across the country asking for their comments on recommendations.Results:The agreed recommendations were accepted as conclusive while those with no agreement were discussed at the consensus session. Finally, all customized recommendations were codified as 80 recommendations along with their sources and levels of evidence for the Iranian population.Conclusion:Customization of CPGs for management of adult cataract for the Iranian population seems to be useful for standardization of referral, diagnosis and treatment of patients.

Highlights

Cataract is the progressive deterioration of optical qualities of the crystalline lens.[1,2] The most common form is age‐related cataract which affects a high percentage of people over the age of 50 years.[2]
The use of steroids, amitriptyline, statins, anti‐diabetes pills, insulin, and potassium‐sparing diuretics increase the risk of cataracts and cause faster
In case of posterior capsular rupture and inadequate capsular support for in‐ the‐bag intraocular lens (IOL) implantation, ACIOLs, scleral fixation PCIOLs, or iris fixation IOLs may be used.[179] (III), (C39) 69‐ 1‐ Intracameral antibiotic injections are not recommended to reduce the chance of endophthalmitis due to the toxic effects and likelihood of reduction in corneal endothelial cells.[180,181,182,183,184,185,186,187] (III), (A28) - (IV), (Internal and external consensus) 69‐2‐ Subconjunctival antibiotic injection may be recommended to reduce the chance of postoperative endophthalmitis with weak level of evidence.[180,181,182,183,184,185,186,187] (III), (A28)

Summary

Introduction

Cataract is the progressive deterioration of optical qualities of the crystalline lens.[1,2] The most common form is age‐related cataract which affects a high percentage of people over the age of 50 years.[2] Cataract has been reported to be the cause of 47.8% of all cases of blindness worldwide and are a serious health issue in developing countries.[3] In Iran, cataract is are highly prevalent, and based on two studies performed on Tehran citizens over 40 years, a prevalence of 12% to 19.1% has been reported.[4,5] Another study from Varamin district has reported cataract as the cause of blindness in 31.7% of cases and severe visual acuity impairment in 47.5% of cases.[6] Currently, the only option for visual rehabilitation in human subjects with cataract is surgical removal of the lens,[7] which is one of the most successful surgical treatments.[2] This surgery has vastly changed during the past 20 years,[8] and with advances in microscopic surgery and intraocular lens (IOL) manufacturing, the quality of vision after surgery has dramatically improved, leading to more cases of surgical treatment being performed.[9]

Methods

Results

Conclusion