For many years, pars plana vitrectomy with posterior hyaloid detachment and peeling of internal limiting membrane (ILM) has been considered a treatment option for diabetic macular edema by retina surgeons worldwide.

The 2012 large scale study by EVRS surgeons showed that the surgical option alone resulted, by far, in the most significant visual acuity improvement. However the surgical treatment has, so far, failed to gain widespread consensus as a superior option in the anti-VEGF era.

The advantages and disadvantages of medical vs surgical treatment will be discussed, along with clinical cases that illustrate that anatomical and functional improvement are not always predictable.