The development and new achievements of the last 30 years in vitreo-retinal surgery, since Machemer developed pars plana vitrectomy as surgical treatment of diabetic retinopathy, have led to a marked change of indications as well as surgical techniques which are applied in this disease. Surgical indications in severe proliferative diabetic retinopathy are: severe vitreous hemorrhage, tractional retinal detachment recently involving the macula, combined tractional and regmatogenous retinal detachment, severe fibrovascular proliferation, premacular dense hemorrhage, chronic macular edema, hemolytic glaucoma and anterior segment neovascularization with media opacity.