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Subretinal saline injection added to vitrectomy for diabetic macular edema with hard exudatesDoes a simple salt solution injection help eyes with diabetic swelling?

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Key Takeaway
Consider subretinal saline injection during vitrectomy as an experimental approach for DME with hard exudates, pending larger comparative trials.

This randomized controlled trial enrolled 56 patients with diabetic macular edema and hard exudates. The intervention group received pars plana vitrectomy with internal limiting membrane peeling plus a subretinal injection of balanced salt solution, while the control group received vitrectomy and peeling alone. The mean follow-up was 7.13 ± 2.02 months.

Within the injection group, best-corrected visual acuity (Snellen) improved from 20/426 ± 20/98 to 20/163 ± 20/59 (P < 0.001). Central macular thickness decreased from 453.32 ± 125.90 µm to 305.14 ± 119.23 µm (P < 0.001). The hard exudates area decreased from 3.00 ± 1.68 mm² to 1.50 ± 1.24 mm² (P < 0.001). The foveal avascular zone area decreased from 0.41 ± 0.11 mm² to 0.32 ± 0.11 mm² (P < 0.001), and mean macular thickness decreased from 411.77 ± 64.52 µm to 322.96 ± 52.62 µm (P < 0.001). All reported P-values are for within-group changes.

Postoperative complications did not differ between groups (P > 0.05). Adverse events, serious adverse events, and discontinuation rates were not reported. Key limitations include the lack of a specified primary outcome, the absence of reported effect sizes or confidence intervals for between-group comparisons, and a short-term follow-up of approximately 7 months. The trial's small size (56 patients) and unreported funding or conflicts of interest are also notable.

For clinical practice, this single, small RCT suggests a potential association between adding a subretinal saline injection to vitrectomy and anatomical improvements in a specific DME subgroup. However, the evidence is insufficient to establish superiority over standard surgery due to the lack of direct between-group statistical comparisons and long-term data. The procedure's safety profile beyond immediate postoperative complications remains unclear.

Imagine waking up and realizing your vision is blurry because of fluid buildup in your retina. For people with diabetic macular edema and hard exudates, this is a serious challenge. A recent study looked at whether adding a subretinal balanced salt solution injection to standard eye surgery could help. The surgery involves removing scar tissue and peeling a thin inner layer of the eye wall. The injection was given right under the retina during this procedure.

The results were promising for the people in the study. Those who received the salt solution injection saw their vision improve significantly. Their central macular thickness, which measures swelling, dropped sharply. The area of hard exudates also shrank, and the healthy blood flow zone in the center of the eye improved. These changes happened within an average follow-up of about seven months.

Safety seemed comparable between the two groups. Postoperative complications did not differ significantly between those who got the injection and those who did not. However, this study has important limits. It involved only 56 patients, and the researchers did not report confidence intervals or effect sizes for the comparison between groups. We also do not know if these benefits last much longer than seven months. Until more data is available, this remains an interesting finding rather than a definitive rule for all patients.

What this means for you:
A salt solution injection with surgery improved vision and swelling in a small group of patients with diabetic eye disease.

Study Details

Study typeRct
Sample sizen = 28
EvidenceLevel 2
Follow-up2.0 mo
PublishedApr 2026
View Original Abstract ↓
PURPOSE: To evaluate the efficacy and safety of subretinal balanced salt solution injection for diabetic macular edema patients with hard exudates (HEs) using a 40-gauge curved needle. METHODS: Patients with diabetic macular edema with HEs were randomized to injection group (subretinal balanced salt solution injection combined with pars plana vitrectomy and internal limiting membrane peeling, n = 28) or control group (pars plana vitrectomy and internal limiting membrane peeling, n = 28). Changes in best-corrected visual acuity, central macular thickness, HEs, foveal avascular zone, and mean macular thickness were compared. Patient demographics, laboratory results, and surgical complications were recorded and compared. RESULTS: Baseline characteristics were similar ( P > 0.05). In the injection group, compared with the preoperative indicators, the postoperative best-corrected visual acuity (Snellen) improved from 20/426 ± 20/98 to 20/163 ± 20/59, central macular thickness decreased from 453.32 ± 125.90 µ m to 305.14 ± 119.23 µ m, HEs area decreased from 3.00 ± 1.68 mm 2 to 1.50 ± 1.24 mm 2 , foveal avascular zone area decreased from 0.41 ± 0.11 mm 2 to 0.32 ± 0.11 mm 2 , and mean macular thickness decreased from 411.77 ± 64.52 µ m to 322.96 ± 52.62 µ m ( P < 0.001, respectively). Postoperative best-corrected visual acuity, central macular thickness, HEs area, foveal avascular zone, and mean macular thickness in the injection group were different from those in the control group ( P < 0.05). Postoperative complications did not differ ( P > 0.05). The mean follow-up duration was 7.13 ± 2.02 months. CONCLUSION: Subretinal balanced salt solution injection with a 40-gauge curved needle is safe and effective for diabetic macular edema with HEs, improving macular structure and vision.
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