ILM Peeling for Refractory Diabetic Macular Edema using intra-operative OCT

Diabetic macular edema (DME) is a vision-threatening condition and the leading cause of vision loss among working-age individuals. However, up to 23% of patients do not respond adequately to standard therapies. Previous studies have suggested that the internal limiting membrane (ILM) in diabetic patients tends to be thicker and contains a higher density of inflammatory cells, contributing to Müller cell traction, impaired diffusion of intravitreal anti-angiogenic agents, and perpetuation of the inflammatory process. Theoretically, ILM peeling may alleviate these factors, promoting anatomical and functional improvement. Herein, we describe the use of intraoperative optical coherence tomography (i-OCT) during pars plana vitrectomy combined with ILM peeling for the treatment of refractory DME without vitreomacular traction, in which satisfactory anatomical outcomes were achieved. Since i-OCT is a relatively recent technology, there remains limited evidence (particularly in the national context) regarding its benefits, its role in pre and intraoperative decision-making, and its impact on postoperative outcomes. We believe that, by enhancing surgical safety using i-OCT, PPV with ILM peeling is an effective treatment option for selected cases of refractory DME.