Microinvasive pars plana vitrectomy versus panretinal photocoagulation for severe non-proliferative diabetic retinopathy: a randomised controlled trial
In brief
Microinvasive vitrectomy shows zero progression to proliferative retinopathy versus 7% with laser, while sparing peripheral vision
In a 12-month randomized trial of 55 eyes with severe non-proliferative diabetic retinopathy, none of the eyes treated by microinvasive pars plana vitrectomy progressed to proliferative disease, compared with 2 of 28 (7%) after pan-retinal photocoagulation. The vitrectomy group also lost far less peripheral visual field sensitivity. These findings suggest surgery may protect visual function without increasing progression risk, but larger studies are needed to confirm durability.
- Journal
- The British journal of ophthalmology (Q1)
- Published
- 17 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Zhuangling Lin, Wenbin Zheng, Xiaohu Ding, Baoyi Liu, Ling Jin, Kunbei Lai, et al.
- PMID
- 42469016
- DOI
- 10.1136/bjo-2025-328536
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 19 July 2026): Micro‑invasive PPV vs PRP for severe NPDR, progression outcomes
Abstract
PURPOSE: To evaluate the progression rate of severe non-proliferative diabetic retinopathy (sNPDR) in eyes treated with microinvasive pars plana vitrectomy (PPV) versus panretinal photocoagulation (PRP) over 12 months. METHODS: 55 eyes of 55 diabetic patients aged >18 years with sNPDR were randomised 1:1 to the PPV group (n=27) or the PRP group (n=28). Standard 25G PPV was performed by an experienced surgeon within 4 weeks of enrolment. Standard PRP was performed in three sessions within 4 weeks of enrolment. The primary outcome was the proportion of eyes progressed from sNPDR to proliferative diabetic retinopathy (PDR) over 12 months. RESULTS: A total of 27 participants (mean (SD) age, 61.19 (8.89) years; 16 male (59.3%)) in the PPV group and 28 participants (mean (SD) age, 60.50 (7.93) years; 11 male (39.3%)) in the PRP group were analysed. At 12 months, no patients in the PPV group progressed to PDR, compared with 2 of 28 patients (7.1%) in the PRP group (p=0.49). The mean (SD) change in total visual field point score was -16.70 (415.23) dB in the PPV group and -314.00 (404.59) dB in the PRP group (p=0.02). For the peripheral 60-4 test, the mean (SD) change was -11.39 (167.99) dB in the PPV group versus -207.05 (308.66) dB in the PRP group (p=0.02). CONCLUSIONS: In patients with sNPDR, PPV and PRP showed no significant difference in PDR progression during the 12-month follow-up, whereas the PPV group preserved better peripheral visual function. TRIAL REGISTRATION NUMBER: NCT04103671.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.