12 Patients with severe DME (CMT > 350 microns) were prospectively enrolled. Wide field Optos fluorescein angiography to determine areas of poor peripheral perfusion. Patients then underwent an injection of Avastin and PRP directed to areas of poor perfusion. Two more monthly injections of Avastin were given. If at the end of 4 months observation period DME persisted, wide field angiography was repeated and more PRP was applied to areas of untreated or undertreated ischemic retina. An additional Avastin injection was given. Patients were followed for at least one year. At one year 85% of patients showed no edema. The majority of patients were injection free for at least 6 months. We conclude that targeted PRP with limited injections is effective in resolving DME.