 To investigate the role of ranibizumab and angiographically-directed peripheral scatter laser therapy in patients with clinically-significant diabetic macular edema CSME and peripheral nonperfusion. We propose a novel treatment of CSME in a subgroup of patients defined by a combination of ultrawide-field angiography UWFA and optical coherence tomography OCT. Within this classification scheme, patients with CSME are subdivided by the presence of: 1 focal macular leakage, 2 vitreomacular interface traction, andor 3 peripheral nonperfusion. The successful treatment of diabetic macular edema would be dictated by pathophysiology-directed therapy based on this classification. 