What are the guidelines for Proliferative Diabetic Retinopathy (PDR)?

From the Guidelines

Patients with Proliferative Diabetic Retinopathy (PDR) should be promptly referred to an ophthalmologist who is knowledgeable and experienced in the management and treatment of diabetic retinopathy, and laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with high-risk PDR, as recommended by the most recent guidelines 1. The guidelines for PDR emphasize the importance of early detection and treatment to prevent vision loss.

• Patients with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes, while patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis 1.
• Subsequent examinations for both type 1 and type 2 diabetic patients should be repeated annually by an ophthalmologist or optometrist who is knowledgeable and experienced in diagnosing the presence of diabetic retinopathy and is aware of its management, with more frequent exams if retinopathy is progressing 1.
• The presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection, as this therapy does not pose a risk, and patients with any level of macular edema, severe NPDR, or any PDR require prompt care from an ophthalmologist 1.
• Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with high-risk PDR, clinically significant macular edema, and in some cases of severe NPDR, and the treatment of PDR may involve anti-VEGF therapy, laser photocoagulation, or vitrectomy surgery, depending on the severity of the disease and the availability of resources 1.

From the Research

Guidelines for Proliferative Diabetic Retinopathy (PDR)

• The treatment of PDR involves the use of anti-vascular endothelial growth factor (VEGF) therapy or panretinal photocoagulation (PRP) 2.
• The Diabetic Retinopathy Clinical Research Network (DRCR.net) Protocol S provides guidelines for the treatment of PDR using ranibizumab, which involves monthly injections for 6 months unless resolution is achieved after 4 injections 2.
• After 6 months, injections can be deferred if neovascularization is stable over 3 consecutive visits, but monthly treatment can be resumed if neovascularization worsens 2.
• The use of anti-VEGF molecules is considered a first-line choice for the management of diabetic retinopathy, including PDR 3.
• Laser treatments, such as PRP, may have a role in selected advanced cases and for patients unable to guarantee enough compliance to intravitreal treatments 3.
• The choice between anti-VEGF and PRP as first-line therapy for PDR should be guided by consideration of the relative advantages of each therapeutic method and anticipated patient compliance with follow-up and treatment recommendations 2.

Laser Treatment for PDR

• Different laser modalities, such as Nd:YAG and diode lasers, have been compared to standard argon laser for the treatment of PDR, but the evidence is limited and of low certainty 4.
• Modifications to the standard argon laser PRP technique, such as "light intensity" PRP and "centre sparing" PRP, have also been evaluated, but the evidence is limited and of low certainty 4.

Anti-VEGF Therapy for PDR

• Ranibizumab is an anti-VEGF molecule that has been shown to be effective in the treatment of PDR, with significant reductions in neovascularization and improvement in visual acuity 2.
• Other anti-VEGF molecules, such as bevacizumab and aflibercept, are also available and may be used in the treatment of PDR, but the evidence is limited and more research is needed to determine their efficacy and safety 3.