Diabetic macular edema is a multifactorial disorder that needs a multimodal and individualized approach. First we must understand the main mechanism behind each particular case (ischemic, inflammatory, tractional or even mixed) and then select the best treatment option. If it is not possible to clarify the main mechanism (which can change with time, as the natural history of this ocular disease) we should always choose the best way that can allow us to keep the best vision for the longest possible time, without compromising the long-term prognosis. We should use a step-by-step strategy, depending always on the severity and context. Laser therapy is the first option in focal macular edema, co-adjuvanted with anti-angiogenic or corticosteroid intravitreal injections when the edema is central and diffuse. Vitrectomy may be a powerful weapon but sometimes kills the other options when it fails, although when macular traction is evident this become the first choice. I will show statistics and examples that illustrate the support for this treatment methodology.