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Î Laser surgery, color fundus photography, and fluorescein angiography
are NOT indicated for patients with normal retinal examinations or
minimal NPDR. (III, G, S)
Î Laser surgery and fluorescein angiography are NOT indicated for mild
to moderate NPDR without macular edema. (III, G, S)
Î Panretinal photocoagulation should NOT be recommended for eyes with
mild or moderate NPDR, provided that follow-up can be maintained.
(I++, G, S)
Î When retinopathy is more severe, panretinal photocoagulation should
be considered and should not be delayed when the eye reaches the
high-risk proliferative stage. (I++, G, S)
Î Additional panretinal photocoagulation or vitrectomy may be required
for increasing neovascularization of the iris and may be considered for
the following indications: failure of the neovascularization to regress;
increasing neovascularization of the retina or iris; new vitreous
hemorrhage; new areas of neovascularization. (III, In, D)
Î Vitreous hemorrhages following extensive panretinal photocoagulation
may clear spontaneously and do not necessarily require additional
laser surgery. (III, In, D)
Î Some patients with previously untreated PDR who have vitreous
opacities and active neovascular or fibrovascular proliferation should
be considered candidates for pars plana vitrectomy. (I++, G, S)
Î In some patients with severe vitreous or preretinal hemorrhage, in
which advanced, active PDR persists despite extensive panretinal
photocoagulation, vitrectomy surgery may be indicated. (III, In, D)
Î Vitreous surgery is frequently indicated in patients with traction
macular detachment (particularly of recent onset), combined traction-
rhegmatogenous retinal detachment, and vitreous hemorrhage
precluding panretinal photocoagulation. (III, In, D)
Î Patients with vitreous hemorrhage and rubeosis iridis also should
be considered for prompt vitrectomy and intraoperative panretinal
photocoagulation surgery. (III, In, D)
Î Many retina specialists prefer a less intense laser treatment, greater
spacing, directly targeting microaneurysms, and avoiding foveal
vasculature within at least 500 μm of the center of the macula.
(I++, G, D)
Î A follow-up examination for individuals with CSME should be scheduled
within 3–4 months of laser surgery. (III, G, S)
Î Careful follow-up at 3–4 months is important: if the patient will not
or cannot be followed closely or if there are associated medical
conditions such as impending cataract surgery or pregnancy, then
early laser photocoagulation may be warranted. (III, G, S)
