Internal Limiting Peeling in Conjunction with Subretinal Injection of a Balanced Salt Solution in the Macular Region to Treat Refractory Diabetic Macular Edema.

Background:Diabetic macular edema (DME) is one of the primary causes of decreased visual acuity in patients with diabetic retinopathy (DR). Rapid, effective, and safe treatment of DME is important to ensure patients' vision. Objective:In this study, we observed the efficacy and safety of internal limiting membrane (ILM) peeling in conjunction with subretinal injection of balanced salt solution (BSS) in treating refractory DME. Methods:A prospective, non-case-control study. Patients diagnosed with refractory DME in our hospital between October 2021 and June 2022 were included. All patients received 23G PPV in conjunction with internal limiting membrane removal and subretinal injection of BSS. During and after surgery, intravitreal injections of an anti-VEGF drug were administered. We compared and analyzed the best-corrected visual acuities (BCVA), central macular thickness (CMT), recurrence rate, complications, and other observation indicators. Results:The investigation included 32 patients (32 eyes). The BCVA at each time point after surgery was significantly higher than it was before the surgery (P < .001). One month after the surgery, the BCVA was significantly higher than it was before surgery and one week after the surgery. Postoperative CMT was statistically significantly lower than before surgery, and the difference was statistically significant (P < .001). One month after surgery, CMT was significantly lower than before and one week after surgery, and the difference was statistically significant (P < .001). Still, there was no significant difference between three and six months after surgery. Three times of intravitreal injections of anti-VEGF drugs were administered. At the most recent follow-up, DME recurred in three eyes (9.4%). During the follow-up period, no complications such as vitreous hemorrhage, retinal detachment, macular epiretinal membrane, or macular hole were observed. Conclusion:Subretinal injection of BSS can be an effective treatment for refractory DME and is recommended for clinical use.