What I am going to show is that while in focal ME (in CSCh or in NPDR or in TAE etc.), the primary laser treatment is very efficient and almost harmless, thus I recommend laser primarily in these cases. In diffuse edema (as in BRVO, CRVO, DR, Irvine-Gass, uveitis et al), laser coagulation is controversial (often inefficient and even harmful). I will express my embarrassment about the proper choice of the best method of treatment and rather ask questions than give answers:

1. Should we better start with less radical treatment (anti-VEGF, eventually supplemented with mild laser when the edema is reduced, or TMC) and proceed to PPV only when it is not sufficient, or

2. Should we primarily perform the most radical procedure – PPV+ILM peel (with possible risks and the possibility of failure) and apply supplemental Avastin or TMC or laser only later when the expected effect does not materialize. I will show that the combination of Avastin and 1 week later PPV+ILM peel+laser+TMC+Air can be successful but later the CME can reoccur, with or without worsening of the vision. I will show pale optic discs after vitrectomy with ILM peel (which can be ischemic but we cannot exclude iatrogenic damage). I will mention the paradox that some patients are afraid of surgery and they prefer Avastin and laser, while others for rather ridiculous reasons (they do not want to pay 168 EUR for Avastin) prefer vitrectomy (because it is covered by the insurance). I will conclude that an individualized treatment, tailored to the findings, to the patient´s needs, to his wishes and abilities, modified by the experience and intuition of the surgeon, is preferred to some strict “guidelines” or even “directions”.
Even if the EVRS study brings definite conclusions, each patient is different and his feelings and hopes and fears are different; also every surgeon is different and we should not blame someone who is more conservative and cautious nor someone who has best results with surgical solutions.