Purpose: To describe a novel surgical approach for eyes with persistent macular edema (ME) complicated by intracystic hyperreflective material. Methods: Pars plana vitrectomy and dye-assisted internal limiting membrane (ILM) peeling were performed in cases with chronic and/or refractory intracystic hyperreflective material. Microscope-integrated optical coherence tomography (OCT) was used to localize cysts and intracystic hyperreflective material, perform cyst puncture, and monitor cyst collapse. Functional and structural outcomes were assessed longitudinally over a minimum follow-up of 3 months. Results: Decimal visual acuity improved from a median of 0.28 (20/71.4) to 0.50 (20/40) over a median follow-up of 6 months. No patient required repeat intravitreal injection or experienced recurrence of intracystic hyperreflective material. Conclusions: ILM peeling combined with integrated OCT-guided cyst puncture may improve outcomes and reduce treatment burden in eyes with persistent ME and intracystic hyperreflective material. Additional controlled studies are needed to establish the broader utility of this technique.
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