Diabetic vitreous hemorrhage secondary to proliferative diabetic retinopathy is a cause of severe vision loss in diabetic patients. Laser photocoagulation remains the primary treatment when the view allows. Intravitreous anti-VEGF injections do not appear to have a role as primary treatment but may have an invaluable role as adjuvant to surgery. Pars plana vitrectomy with endolaser panretinal photocoagulation remains the procedure of choice for non-clearing vitreous hemorrhage. The vast majority of patients with vision of 5/200 or less due to diabetic vitreous hemorrhage do not clear spontaneously even after 1 year. With improvements in surgical techniques leading to better outcomes, fewer complications, less discomfort and a faster recovery time it is reasonable to operate on such patients sooner than the 3–4 months that had been generally accepted in the past, if there has been no significant spontaneous improvement.