PurposeThis study evaluated the outcomes of surgical cystotomy for recurrent diabetic cystoid macular edema (CME).Patients and methodsWe analyzed 20 eyes with a clinical diagnosis of diabetic retinopathy and refractory CME. Release of vitreoretinal adhesion, epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling and cystotomy guided by intraoperative optical coherence tomography (iOCT) were performed in every patient. Pars plana vitrectomy was also performed in 17 patients, 11 of whom also underwent lensectomy and intraocular lens implantation. Central retinal thickness (CRT), central minimum macular thickness (CMMT), macular volume (MV) and best-corrected visual acuity (BCVA) were compared preoperatively and 1 and 6 months post surgery.ResultsCRT, CMMT and MV significantly improved 1 and 6 months post surgery in each group (P<0.01). Significant improvements in BCVA were only observed 6 months post surgery (P<0.01). No intra- or postoperative complications were observed in all patients.ConclusionCRT, CMMT, MV and BCVA significantly improved 6 months following surgical cystectomy. This implies that iOCT-guided cystotomy could be another treatment option for refractory CME in diabetic eyes.