Should patients undergoing vitrectomy for proliferative diabetic retinopathy (PDR) also receive interactive panretinal photocoagulation (PRP) if it was not completed prior to vitrectomy?

From the Guidelines

Yes, patients undergoing vitrectomy for proliferative diabetic retinopathy (PDR) should generally receive panretinal photocoagulation (PRP) if it was not completed before surgery, as this approach has been shown to reduce the risk of postoperative complications such as recurrent vitreous hemorrhage and progression of neovascularization 1.

Key Considerations

• The most recent and highest quality study, published in 2025, supports the use of PRP in patients with PDR, as it reduces the risk of vision loss and improves long-term visual outcomes 1.
• The Diabetic Retinopathy Study (DRS) and the Early Treatment Diabetic Retinopathy Study (ETDRS) have established the benefits of panretinal photocoagulation in reducing the risk of severe vision loss from PDR 1.
• Ideally, PRP should be performed during the vitrectomy procedure as endolaser photocoagulation, treating the peripheral retina with 1200-1600 laser spots of 200-500 microns in size.
• In cases where complete PRP cannot be achieved during surgery due to media opacity or other technical limitations, additional laser sessions should be scheduled postoperatively once the eye has healed sufficiently, typically 2-4 weeks after surgery.

Alternative Treatment Options

• Intravitreous injections of anti-vascular endothelial growth factor (anti-VEGF) are a reasonable alternative to traditional panretinal laser photocoagulation for some individuals with PDR, and may reduce the risk of vision loss in these individuals 1.
• However, the decision to choose anti-VEGF over PRP must be made cautiously, considering patient-related factors and the potential for inferior outcomes if follow-up is not reliable 1.

From the Research

Treatment of Proliferative Diabetic Retinopathy (PDR)

• Patients undergoing vitrectomy for PDR may benefit from interactive panretinal photocoagulation (PRP) if it was not completed prior to vitrectomy, as it can improve visual outcomes and reduce the risk of complications 2, 3, 4, 5.
• Studies have shown that vitrectomy with endolaser PRP can improve visual acuity and reduce the risk of postoperative complications, such as vitreous hemorrhage and diabetic macular edema 6, 3, 5.
• The timing of vitrectomy and PRP may also be important, with some studies suggesting that early vitrectomy (≤6 weeks) may be associated with better visual outcomes and fewer complications compared to delayed vitrectomy (>6 weeks) 4.
• Preoperative anti-vascular endothelial growth factor (VEGF) treatment and PRP laser treatment may also be associated with lower rates of postoperative complications, such as vitreous hemorrhage 5.
• Intraoperative use of sub-tenon triamcinolone acetonide may be associated with a lower rate of postoperative diabetic macular edema 5.

Key Findings

• Vitrectomy with endolaser PRP can improve visual acuity and reduce the risk of postoperative complications in patients with PDR 6, 3, 5.
• Early vitrectomy (≤6 weeks) may be associated with better visual outcomes and fewer complications compared to delayed vitrectomy (>6 weeks) 4.
• Preoperative anti-VEGF treatment and PRP laser treatment may be associated with lower rates of postoperative complications 5.
• Intraoperative use of sub-tenon triamcinolone acetonide may be associated with a lower rate of postoperative diabetic macular edema 5.

Complications and Risks

• Postoperative complications, such as vitreous hemorrhage, diabetic macular edema, and retinal detachment, may occur after vitrectomy with PRP 6, 3, 5.
• The risk of complications may be reduced with early vitrectomy, preoperative anti-VEGF treatment, and PRP laser treatment, as well as intraoperative use of sub-tenon triamcinolone acetonide 4, 5.