Integrative Management of High-Risk Proliferative Diabetic Retinopathy: Precision Diagnostics via Ultra-Widefield...

Diabetic retinopathy (DR) is a leading cause of blindness worldwide. High-risk proliferative diabetic retinopathy (HR-PDR) is an advanced stage and carries a nearly 50% risk of severe vision loss within five years without intervention. Recent advances in ultra-widefield (UWF) imaging technologies enable comprehensive detection of peripheral lesions and facilitate more accurate diagnosis of disease severity, yet standardized quantitative biomarkers for predicting disease progression remain lacking. Current treatments, including pan-retinal photocoagulation (PRP), anti-vascular endothelial growth factor (anti-VEGF) agents, and pars plana vitrectomy (PPV), demonstrate varying levels of efficacy. There is currently no consensus on the optimal treatment regimen for HR-PDR. Therefore, this review analyzes the application value of UWF imaging in HR-PDR, compares the efficacy of different treatment regimens, and considers their cost-effectiveness and practical applicability meanwhile. Using UWF color fundus photography (CFP) combined with widefield swept-source optical coherence tomography angiography (WF-SS-OCTA) may enhance diagnostic and monitoring outcomes for HR-PDR. Anti-VEGF injections followed PRP could provide stable and sustained protective effects; early PPV may improve outcomes in select cases. Future research should prioritize addressing current research gaps, including the identification of optimal anti-VEGF/PRP protocols, strategies to overcome long-term adherence challenges, establishment of consistent retreatment criteria, clarification of surgical indications, and development of socioeconomic strategies.