Diagnóstico y tratamiento de la retinopatía diabética y edema macular diabético: guía de práctica clínica del Seguro Social de Salud del Perú (EsSalud)

espanolIntroduccion. El presente articulo resume la guia de practica clinica (GPC) para el diagnostico y tratamiento de la retinopatia diabetica y el edema macular diabetico en el Seguro Social de Salud del Peru (EsSalud). Objetivo. Proveer recomendaciones clinicas basadas en evidencia para el diagnostico y tratamiento de la retinopatia diabetica y el edema macular diabetico en EsSalud. Metodos. Se conformo un grupo elaborador de la guia (GEG) que incluyo medicos especialistas y metodologos. El GEG formulo 4 preguntas clinicas a ser respondidas por la presente GPC. Para cada una de estas preguntas se realizo busquedas de revisiones sistematicas y de estudios primarios (cuando se considero pertinente) en PubMed durante el 2018. Se selecciono la evidencia para responder cada una de las preguntas clinicas planteadas. La certeza de la evidencia fue evaluada usando la metodologia Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periodicas, el GEG uso la metodologia GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buena practica clinica y el flujograma de manejo. Resultados. La presente GPC abordo 4 preguntas clinicas sobre el tamizaje, diagnostico, tratamiento de eleccion y tratamiento adyuvante. En base a estas preguntas se formularon 6 recomendaciones (4 fuertes y 2 condicionales), 19 puntos de buena practica clinica y 1 flujograma de manejo. Conclusion.El presente articulo resume la metodologia y las conclusiones basadas en evidencias de la GPC para el diagnostico y tratamiento de la retinopatia diabetica y el edema macular diabetico en EsSalud EnglishIntroduction. This article summarizes the clinical practice guidelines (CPG) for the diagnosis and treatment of diabetic retinopathy and diabetic macular edema of the Health Social Security of Peru (EsSalud). Objective. To provide clinical recommendations based on evidence for the diagnosis and treatment of diabetic retinopathy and diabetic macular edema in EsSalud. Methods. A guidelines elaborating group (GEG) was conformed by medical specialists and methodologists. The GEG formulated 4 clinical questions intended to be answered by this CPG. For each of these questions systematic searches of systematic reviews and primary studies (when considered pertinent) were carried out in PubMed during 2018. Evidence was selected in order to reply each of the proposed clinical questions. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. During periodic working meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice and the management flowchart. Results. The present CPG addressed 4 clinical questions of four topics: screening, diagnosis, treatment of choice and adjuvant treatment. Based on these questions, 6 recommendations (4 strong and 2 conditional), 19 points of good clinical practice, and 1 management flowchart were formulated. Conclusion. This article summarizes the methodology and conclusions based on evidence from the CPG for the diagnosis and treatment of diabetic retinopathy and diabetic macular edema in EsSalud