Technological advances in 23 gauge probe design and vitrectomy machines, allowed the use of the probe to perform many intraoperative techniques and manipulations during complex diabetic vitrectomy. The aim of this work is to describe techniques for using the 23 gauge vitrectomy probe to manage complex diabetic vitrectomy. 120 eyes with severe complications of proliferative diabetic retinopathy were included in this work. They include cases with no PVD, combined traction/rhegmatogenous RD, extensive fibrovascular proliferation extending to the periphery, chronic traction RD and eyes with active neovascularization. The 23 gauge probe can be used effectively to define planes, elevate and manipulate tissues, acting as horizontally and vertically cutting scissors and actively remove blood and viscid subretinal fluid. Bimanual surgery, in case the underlying retina is becoming mobile can be performed using forceps and the probe. The surgical goals could be achieved in all cases. In conclusion, the 23 gauge probe largely replaced scissors, forceps, flute cannulas in most cases with severe complications of proliferative diabetic retinopathy.