In contrast, a single case report [17] demonstrated a deterioration in VA with the use of Avastin [TM] for chronic, refractory DME in a 58-year-old woman who had undergone multiple previous treatments including laser photocoagulation and intravitreal triamcinolone (steroid) injections. The authors felt that using Avastin [TM] in this way exacerbated macular ischaemia by disrupting an already fragile perfusion status. It is difficult to attribute the poor outcome fully to the antiVEGF drug, but the report highlights our need to examine the effects of antiVEGF in ischaemic DME more closely.