Treatment of Diabetic Retinopathy After Photocoagulation and Anti-VEGF Therapy Fail to Achieve Regression of Neovascularization
Clinical Scenario
This protocol addresses patients with high-risk proliferative diabetic retinopathy (PDR) or neovascular glaucoma. High-risk PDR is defined by new vessels accompanied by vitreous hemorrhage, or by neovascularisation of the disc occupying at least one-quarter to one-third disc area even without vitreous hemorrhage. Patients in this group require prompt, escalated management.
Previous treatment — target not reached
Prior therapy with additional panretinal (scatter) photocoagulation surgery and/or intravitreal anti-VEGF did not achieve the required goal of regression of retinal neovascularization. This protocol defines the structured next step after that failure.
Next-Line Approach (partial overview)
Pars plana vitrectomy is considered at this stage for patients with specific vitreous or retinal complications. The full protocol defines the precise indications, criteria, and decision pathway — these are not listed here.
Clinical Goal
Improvement in visual acuity.
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).
- Pars plana vitrectomy should be considered for patients with PDR and vitreous opacities interfering with vision or treatment, severe fibrovascular proliferation, and tractional retinal detachment that is threatening or involving the macula.
- The DRVS demonstrated improved outcomes if vitrectomy for vitreous hemorrhage is done within 1 to 6 months of onset compared with later vitrectomy at 1 year.
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