Three-year outcomes of cystotomy and fibrinogen clot removal for diabetic macular edema with subfoveal cystoid macular edema

Several new surgical techniques for managing refractory diabetic macular edema (DME) have demonstrated favorable short-term outcomes. However, no studies have reported the long-term outcomes of these treatments. This study aimed to evaluate the long-term outcomes of cystotomy for DME retrospectively. Twenty-seven patients (31 eyes; 16 male, 11 female) who underwent cystotomy for DME between January 2015 and April 2019, with a follow-up period of 3 years were included. Statistical analyses involved variables including age, sex, best-corrected visual acuity (BCVA), central macular thickness (CMT), number of treatments (anti-vascular endothelial growth factor, sub-Tenon injection of triamcinolone acetonide, direct photocoagulation for microaneurysms, vitrectomy with internal limiting membrane peeling), number of clinic visits, and DME recurrence. The mean age was 67.2 ± 9.3 years. BCVA (logMAR) and CMT(µm) significantly improved from preoperatively to 3 years postoperatively (P < 0.001). Total treatments significantly decreased from the year before surgery to the third year after surgery (P < 0.001). The mean number of clinic visits significantly decreased from the year before surgery to the third year after surgery (P < 0.001). Fibrinogen clot removal was performed in 14 eyes. and DME recurrence occurred in 12 eyes. Cystotomy may be a viable treatment option for DME.