Surgical outcomes in PDR are directly related to disease severity. Three additional factors are critical: accurate perioperative assessment based on surgical experience, proficient surgical skills developed through structured mentorship, and reliable equipment that allows the surgeon to perform effectively. Although minimally invasive vitrectomy has substantially advanced PDR surgery, the expanding concepts and techniques can be confusing for beginners. This chapter begins with the anatomical pathology of PDR and then discusses surgical planning and commonly used operative techniques.