Proliferative Diabetic Retinopathy and Cataract: Treatment Strategies and Current Approaches

Proliferative diabetic retinopathy (PDR) represents the most advanced stage of diabetic retinal disease and is characterized by abnormal neovascularization on the retinal surface. These fragile new vessels can lead to vitreous hemorrhage, fibrovascular membrane formation, and tractional retinal detachment. Cataract frequently coexists in patients with PDR and may significantly impair visual acuity. However, cataract surgery in these patients poses unique risks, including exacerbation of the underlying retinopathy and increased chances of postoperative complications such as vitreous hemorrhage and tractional events. Therefore, the timing of surgery, preoperative retinal stabilization, and intraoperative techniques are critical in achieving favorable outcomes. Recent advances have included the use of anti-VEGF therapy prior to surgery, combined surgical approaches such as phacoemulsification with pars plana vitrectomy, individualized intraocular lens (IOL) selection, and refined postoperative monitoring strategies. This review provides a comprehensive overview of the perioperative management of cataract surgery in eyes with PDR, based on current literature. The goal is to support ophthalmologists in minimizing complications and maximizing visual rehabilitation in this complex patient group.