This multicenter randomized controlled trial examines the effectiveness of anti-VEGF (vascular endothelial growth factor) injections in patients with treatment-resistant diabetic retinopathy. The study enrolled 180 patients across six ophthalmology centers in Bangladesh over a 24-month period. Results indicate significant improvement in visual acuity and reduction in macular edema over a 12-month follow-up period. The research provides evidence-based protocols for managing complex diabetic retinopathy cases and contributes to the growing body of literature on advanced retinal disease management.