In diabetic retinopathy with high-risk neovascularization, which treatment is recommended?

• A. Anti-VEGF injections for CME or NV
• B. PRP for high-risk NV
• C. Vitrectomy for any vitreous hemorrhage
• D. Observation only

Answer: (B)

Panretinal photocoagulation is the recommended approach when there is high-risk neovascularization in diabetic retinopathy because it directly targets the underlying stimulus for neovascular growth. By ablating the peripheral retina, PRP reduces retinal ischemia and the subsequent VEGF production, which lowers the drive for new abnormal vessels and decreases the risk of vitreous hemorrhage and tractional retinal detachment, ultimately reducing the chance of severe vision loss.

Anti-VEGF injections can rapidly regress neovascularization and help with macular edema, and may be used as an adjunct or when PRP isn’t feasible, but they aren’t considered the definitive treatment for high-risk proliferative disease in most cases. Vitrectomy is reserved for non-clearing vitreous hemorrhage or tractional complications, not as the first-line therapy for all high-risk neovascularization. Observation alone would allow progression and worsen outcomes.