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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Ophthalmology

Standard of Care Treatments and Procedures

At a Glance

Diabetic retinopathy treatment is individualized: anti-VEGF injections often treat vision-threatening swelling or proliferative disease, while laser, steroid implants, or vitrectomy may be used for specific findings. Staying on schedule is essential because untreated abnormal vessels can bleed.

Modern medicine offers several highly effective ways to manage diabetic retinopathy, but the “best” treatment depends entirely on your stage of disease, whether you have swelling in the center of your vision (Diabetic Macular Edema or DME), your visual acuity, and your ability to attend frequent appointments.

Intravitreal Injections (Anti-VEGF)

For people with vision-impairing, center-involving DME, or for those with Proliferative Diabetic Retinopathy (PDR), anti-VEGF injections are a common frontline treatment [1][2]. These medications—including aflibercept, ranibizumab, bevacizumab (often used off-label), and faricimab—work by blocking the protein (VEGF) that causes blood vessels to leak and grow abnormally [3].

  • How they work: The eye is thoroughly numbed and cleaned, and the medication is injected through the white wall of the eye (the sclera) into the gel-filled cavity (vitreous) in the back of the eye [2].
  • What to expect: You may experience temporary irritation, a red spot where the needle entered (subconjunctival hemorrhage), or new temporary floaters.
  • The Schedule: Treatment usually begins with a “loading phase” of frequent injections. The schedule is highly individualized; some people are eventually able to space out their injections, while others need ongoing, frequent doses [4][5].

Laser Treatments

Laser therapy has been a cornerstone of treatment for decades. While injections have replaced lasers for some patients, lasers still play a vital role in protecting your long-term vision [6].

  • Panretinal Photocoagulation (PRP): This is used for Proliferative Diabetic Retinopathy (PDR). The laser is applied to the peripheral (side) retina to shrink abnormal new blood vessels. While it may slightly reduce your side or night vision, it is highly effective at preventing severe vision loss and offers a more durable, longer-lasting effect than injections alone [7][8].
  • Focal or Grid Laser: This is sometimes used for specific areas of leakage in the macula, particularly for non-center-involving DME [9][10].

Corticosteroid Implants

If anti-VEGF injections do not dry up the fluid in your retina, your doctor may suggest a steroid implant (such as dexamethasone or fluocinolone) [11]. These implants slowly release medication over time—dexamethasone lasts several months, while fluocinolone can last much longer. While effective at reducing swelling, they carry a higher risk of causing cataracts (clouding of the eye’s lens) or increasing intraocular pressure (glaucoma risk), which must be monitored closely, especially if you still have your natural lens [12][13].

Vitrectomy (Surgery)

A vitrectomy is a surgical procedure performed in an operating room by a retinal specialist. It is typically reserved for mechanical complications or bleeding, such as:

  • Non-clearing Vitreous Hemorrhage: Bleeding into the eye that does not clear on its own [14].
  • Tractional Retinal Detachment or Epiretinal Membrane: Scar tissue pulling the retina away from the back of the eye, or a membrane causing tractional macular edema [14][15].

A Critical Note on Missed Appointments

If you are being treated for Proliferative (PDR) using only anti-VEGF injections, the medication’s effects are temporary and will wear off. If you miss visits or stop treatment, your risk for recurrence or progression increases. Without the medication, abnormal vessels can grow back and bleed, leading to vision loss [16][17].

If you foresee problems making frequent appointments due to travel or cost, discuss this openly with your team. PRP laser may be a more durable option for PDR that requires less frequent follow-up, though it is not a guarantee and still requires monitoring [6]. If you cannot make an appointment, do not just stop—contact your clinic immediately to make an alternate plan.

Common questions in this guide

What are the main treatments for diabetic retinopathy?
Treatment may include anti-VEGF eye injections, laser therapy, steroid implants, or surgery called vitrectomy. The choice depends on the stage of diabetic retinopathy, whether swelling affects the center of the macula, your vision, and whether you can attend follow-up visits.
How do anti-VEGF injections treat diabetic retinopathy?
Anti-VEGF medicine blocks a protein that makes retinal blood vessels leak or grow abnormally. The medicine is injected into the gel-filled space inside the eye after the eye is numbed and cleaned, and treatment often starts with several frequent injections.
How often are anti-VEGF injections needed?
Treatment usually begins with a loading phase of frequent injections, followed by a schedule tailored to your response. Some people can gradually space out treatments, while others need ongoing frequent injections.
What happens if I miss an injection for proliferative diabetic retinopathy?
The effect of anti-VEGF treatment is temporary, so abnormal blood vessels may grow back and bleed if treatment is delayed or stopped. Contact your eye clinic promptly if you cannot attend; panretinal laser treatment may provide a more durable option for some people but still requires monitoring.
When is laser treatment used for diabetic retinopathy?
Panretinal photocoagulation is commonly used for proliferative diabetic retinopathy to treat abnormal blood vessels in the peripheral retina. Focal or grid laser may be used for selected leakage, especially when diabetic macular edema does not involve the center of the macula.
When might I need surgery for diabetic retinopathy?
Vitrectomy may be recommended when bleeding inside the eye does not clear or when scar tissue pulls on the retina, causing tractional retinal detachment or macular swelling. A retinal specialist performs this surgery in an operating room.
What are steroid implants used for in diabetic macular edema?
Steroid implants such as dexamethasone or fluocinolone may be considered when anti-VEGF injections do not reduce retinal fluid enough. They can increase the risk of cataracts and high pressure inside the eye, so your eye doctor must monitor you.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given my current stage and visual acuity, am I a candidate for anti-VEGF injections, and what is the initial schedule for my treatment?
  2. 2.If we choose anti-VEGF alone for my proliferative disease, what happens if I miss a dose or have to delay an appointment?
  3. 3.Do I have any signs of traction or scar tissue that would make surgery a better option than injections?
  4. 4.If I don't respond well to the first few injections, what is the plan for switching medications or considering a steroid implant or laser?
  5. 5.Is my macular edema 'center-involving,' and how does that change our choice between observation, laser, and injections?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (17)
  1. 1

    Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA).

    Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, et al.

    Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde 2017; (237(4)):185-222 doi:10.1159/000458539.

    PMID: 28423385
  2. 2

    Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema.

    , Wells JA, Glassman AR, et al.

    The New England journal of medicine 2015; (372(13)):1193-203 doi:10.1056/NEJMoa1414264.

    PMID: 25692915
  3. 3

    YOSEMITE and RHINE: Phase 3 Randomized Clinical Trials of Faricimab for Diabetic Macular Edema: Study Design and Rationale.

    Eter N, Singh RP, Abreu F, et al.

    Ophthalmology science 2022; (2(1)):100111 doi:10.1016/j.xops.2021.100111.

    PMID: 36246184
  4. 4

    Intravitreal faricimab for diabetic macular oedema and neovascular age-related macular degeneration: general considerations and practical recommendations by an expert panel of Italian retina specialists.

    Borrelli E, Boscia F, Lanzetta P, et al.

    Eye (London, England) 2025; (39(16)):3005-3014 doi:10.1038/s41433-025-03997-7.

    PMID: 40999227
  5. 5

    Safety and Efficacy of a Treat-and-Extend Regimen of Anti-Vascular Endothelial Growth Factor Agents for Diabetic Macular Edema or Macular Edema Secondary to Retinal Vein Occlusion: A Systematic Review and Meta-Analysis.

    Patil NS, Dhoot AS, Nichani PAH, et al.

    Ophthalmic surgery, lasers & imaging retina 2023; (54(3)):131-138 doi:10.3928/23258160-20230221-04.

    PMID: 36944072
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    LESSONS LEARNED FROM PACORES IN PROLIFERATIVE DIABETIC RETINOPATHY MANAGEMENT, DATA FROM LATIN AMERICA AND SPAIN: The Asbury Lecture 2020.

    Arevalo JF, Beatson B,

    Retina (Philadelphia, Pa.) 2022; (42(1)):4-10 doi:10.1097/IAE.0000000000003226.

    PMID: 34081638
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    Anti-Vascular Endothelial Growth Factor Injections: The New Standard of Care in Proliferative Diabetic Retinopathy?

    Li X, Zarbin MA, Bhagat N

    Developments in ophthalmology 2017; (60()):131-142 doi:10.1159/000459699.

    PMID: 28427072
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    Rationale and Application of the Protocol S Anti-Vascular Endothelial Growth Factor Algorithm for Proliferative Diabetic Retinopathy.

    Sun JK, Glassman AR, Beaulieu WT, et al.

    Ophthalmology 2019; (126(1)):87-95 doi:10.1016/j.ophtha.2018.08.001.

    PMID: 30096354
  9. 9

    First-line treatment algorithm and guidelines in center-involving diabetic macular edema.

    Kodjikian L, Bellocq D, Bandello F, et al.

    European journal of ophthalmology 2019; (29(6)):573-584 doi:10.1177/1120672119857511.

    PMID: 31238719
  10. 10

    [National guidelines for treatment of diabetic retinopathy : Second edition of the national guidelines for treatment of diabetic retinopathy].

    Ziemssen F, Lemmen K, Bertram B, et al.

    Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft 2016; (113(7)):623-38 doi:10.1007/s00347-016-0315-8.

    PMID: 27352282
  11. 11

    Use of intravitreal dexamethasone implants in the treatment of diabetic macular edema: Expert recommendations using a Delphi approach.

    García Layana A, Adán A, Ascaso FJ, et al.

    European journal of ophthalmology 2020; (30(5)):1042-1052 doi:10.1177/1120672119861623.

    PMID: 31291782
  12. 12

    Fluocinolone Acetonide Intravitreal Implant 0.19 mg (ILUVIEN®): A Review in Diabetic Macular Edema.

    Syed YY

    Drugs 2017; (77(5)):575-583 doi:10.1007/s40265-017-0722-4.

    PMID: 28283896
  13. 13

    Fluocinolone acetonide for the treatment of diabetic macular edema.

    Veritti D, Sarao V, Diplotti L, et al.

    Expert opinion on pharmacotherapy 2017; (18(14)):1507-1516 doi:10.1080/14656566.2017.1363182.

    PMID: 28764565
  14. 14

    Vitrectomy for cases of diabetic retinopathy.

    Shaikh N, Kumar V, Ramachandran A, et al.

    Indian journal of ophthalmology 2024; (72(12)):1704-1713 doi:10.4103/IJO.IJO_30_24.

    PMID: 39186637
  15. 15

    PARS PLANA VITRECTOMY FOR DIABETIC MACULAR EDEMA: A Systematic Review, Meta-Analysis, and Synthesis of Safety Literature.

    Jackson TL, Nicod E, Angelis A, et al.

    Retina (Philadelphia, Pa.) 2017; (37(5)):886-895 doi:10.1097/IAE.0000000000001280.

    PMID: 27632713
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    Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Retinopathy: Consequences of Inadvertent Treatment Interruptions.

    Wubben TJ, Johnson MW,

    American journal of ophthalmology 2019; (204()):13-18 doi:10.1016/j.ajo.2019.03.005.

    PMID: 30878488
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    Outcomes of Eyes Lost to Follow-up with Proliferative Diabetic Retinopathy That Received Panretinal Photocoagulation versus Intravitreal Anti-Vascular Endothelial Growth Factor.

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    Ophthalmology 2019; (126(3)):407-413 doi:10.1016/j.ophtha.2018.07.027.

    PMID: 30077614

This page is for informational purposes only and does not constitute medical advice. Treatment choices for diabetic retinopathy should be made with your eye-care team based on your vision, retinal findings, and follow-up needs.

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