**3.1 PDR without DME**

Both PFC and anti-VEGF therapy are feasible therapeutic options. Anti-VEGF therapy is effective in reversing retinal neovascularization (NV) and reducing the risk of developing DME. However, it may not be cost effective overall [24].

A.If starting PFC.

	- If NV worsens significantly, adding PFC should be considered.
	- If NV does not require further anti-VEGF and during the "sustain stability" period DME develops, add focal macular laser or anti-VEGF (**Table 2**).

The advantages and disadvantages of treatment options should be considered, as well as the individual conditions of the patient.

### **3.2 PDR with NCI-DME**

Anti-VEGF therapy has been accepted as a first-line treatment in DME, displacing laser as a second-line therapy. Although some authors suggest the application of laser in NCI-DME [25–27], there are reports where the addition of conventional, subthreshold or micropulse laser does not add benefits to pharmacological monotherapy in any form of presentation [28–30].


*PFC is given only if NV is substantially worse despite anti-VEGF. Onset or worsening of preretinal or vitreous hemorrhage is not necessarily classified as worsening of NV, unless bleeding precludes evaluation of NV.*

**Table 1.**

*Algorithm for the treatment of PDR according to DRCR.net protocol S.*

