When Panretinal Photocoagulation or Anti-VEGF Therapy Has Not Achieved Neovascular Regression in High-Risk PDR or Neovascular Glaucoma
Clinical Scenario
This protocol addresses patients with high-risk proliferative diabetic retinopathy (PDR) — defined by new vessels accompanied by vitreous hemorrhage, or neovascularisation of the disc occupying approximately one-quarter to one-third disc area or more, even without hemorrhage — or with neovascular glaucoma. These patients have already undergone prompt initial treatment, yet retinal neovascularisation persists.
Previous Treatment — Insufficient Response
Initial management with prompt panretinal (scatter) photocoagulation surgery and/or intravitreal anti-VEGF therapy did not achieve the required clinical goal of regression of retinal neovascularization. Persistent or progressing neovascularisation — including new vitreous hemorrhage or new areas of neovascularisation — indicates the need for escalation.
Next-Line Approach (Partial Overview)
When neovascularisation fails to regress after initial therapy, additional photocoagulation and/or intravitreal treatment may be considered in specific clinical circumstances. The complete structured protocol — including the precise clinical triggers and the framework for selecting the appropriate intervention — is available in full below.
Therapeutic goal: Regression of retinal neovascularization.
References
- 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.
- Patients with neovascular glaucoma or high-risk PDR should receive prompt treatment with anti-VEGF agents and PRP (see Care Process and Glossary).
- Additional PRP and/or anti-VEGF therapy should be considered in situations involving the following: failure of the neovascularization to regress; increasing neovascularization of the retina or iris; new vitreous hemorrhage; new areas of neovascularization.
View source ↗