Diabetic retinopathy
ICD-10 H36.0 · ICD-11 9B71.0

Treatment of Diabetic Retinopathy in High-Risk Proliferative Disease or Neovascular Glaucoma

When diabetic retinopathy reaches the stage of high-risk proliferative disease or is complicated by neovascular glaucoma, prompt intervention is essential. This protocol outlines the structured approach to this critical clinical situation.

Clinical Scenario

High-risk proliferative diabetic retinopathy (PDR) is present when new vessels are accompanied by vitreous hemorrhage, or when neovascularization of the disc occupies approximately one-quarter to one-third disc area or more, even without vitreous hemorrhage. Neovascular glaucoma is a serious complication that may occur alongside or as a consequence of this advanced stage and similarly warrants urgent management.

Treatment Approach

Prompt treatment is required. The approach centres on laser photocoagulation surgery and/or intravitreal injection therapy directed at achieving regression of retinal neovascularization. Certain patient profiles and concurrent findings influence which intervention — or combination — is most appropriate.

The complete regimen, including selection criteria, sequencing, and concurrent management considerations, is available in the full structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

  1. When new vessels are accompanied by vitreous hemorrhage, or when NVD occupy greater than or equal to about one-quarter to one-third disc area, even in the absence of vitreous hemorrhage, PDR is considered high-risk.
  2. Patients with neovascular glaucoma or high-risk PDR should receive prompt treatment with anti-VEGF agents and PRP (see Care Process and Glossary).
  3. Most patients with high-risk PDR should receive PRP expeditiously, because it usually induces regression of retinal neovascularization.
  4. The DRCR.net study Protocol S that examined patients with PDR primarily has demonstrated that a series of anti-VEGF injections (ranibizumab was used in this protocol) is noninferior to PRP at 2 years.
  5. Anti-VEGF treatment alone could be considered for patients with reliable follow-up.
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