Surgical PDR in the Era of Anti-VEGF Therapy

Anti-VEGF therapy for proliferative diabetic retinopathy (PDR) is gaining popularity and is now used as a standalone therapy in eyes with high-risk PDR. However, very aggressive fibrosis of the vascular proliferation and tractional retinal detachment can result even with adequate follow-up and can occur within a few weeks of therapy. In this video presentation, we demonstrate the surgical management of advanced PDR in 2 patients less than 50 years of age who underwent prior anti-VEGF and laser therapy (panretinal photocoagulation). A combination of delamination and segmentation is employed to clear the retinal surface of the excessive and adherent fibrovascular proliferation.