Thirteen young diabetic patients with peripheral capillary non perfusion who presented with symptoms of mild maculopathy were reviewed retrospectively. In this group, peripheral retinal ischaemia was often overlooked and a rapidly progressive proliferative retinopathy developed. Fluorescein angiography of the peripheral retina showed capillary closure, but with preservation of arterioles and venules. In this series, half of the eyes lost vision. In seven eyes where the peripheral ischaemia was treated by pan retinal photocoagulation, the maculopathy resolved without any specific laser treatment to the macula. In young diabetics presenting with maculopathy, the peripheral retina should be examined for ischaemia, and if present, pan retinal laser photocoagulation should be performed. Focal treatment for the macular disease can be delayed until after the peripheral photocoagulation, as the maculopathy may remit.