Effect of PPV+ILM Peeling +/- Subretinal Injection of Ringer Lactate in Management of Nontractional Refractory DME

Inclusion Criteria: * Age: above 40 years old. * Patients with type two diabetes mellitus of more than 5 years duration. * Patients with Best corrected visual acuity better than 3/60. * Central macular thickness (CMT) of more than 250 μm despite undergoing six monthly injection of anti-VEGF therapy or corticosteroid or less than 10% reduction in CMT at the last follow up visit. * No evidence of vitreomacular traction. * Lens status: Pseudophakia or clear crystalline lens. Exclusion Criteria: Other causes of macular edema (intraocular inflammation, retinal vein occlusion, Irvin-gass syndrome, pharmacological). * Ischemic maculopathy by FFA. * Presence of bad prognostic signs in OCT such as disorganization of inner retinal layers (DRIL) and extensive disruption of IS-OS junction subfoveally. * Presence of apparent retinal pigment epithelium (RPE) atrophy at or near the macula. * Presence of proliferative diabetic fibrovascular membranes threatening or at the macula. * Presence of diabetic optic atrophy or neuropathy. * Presence of neovascular glaucoma. * Cataractous lens either preoperatively or as intra or postoperative complication. * Vitrectomized Eyes. * A prior intraocular surgery within the past six-months. * Lost follow up