The rationale to perform pars plana vitrectomy (PPV) in the treatment of DME is well explained by improvement of vitreous oxygenation in the context of ischemia due to diabetic retinopathy and hereby reduction of vitreous VEGF and cytokine levels.[12–14] Moreover, clearance of VEGF is increased after PPV.[15] Small gauge vitrectomy presents a proven treatment option in the current treatment of refractory DME.[16,17]. The gene discussed is VEGFA; the disease is ischemia.