The exact pathophysiologic mechanism responsible for DME remains uncertain, retinal hypoxia and various rheological disturbances play a role in the disruption of the inner blood-retinal barrier associated with metabolic alterations.6 The long term circulatory disturbance may lead to functional vascular obstruction, relative retinal ischemia, and release of cytokines such as VEGF. Here, VEGFA is linked to retinal ischemia.