Abstract: The pathological manifestation of diabetic macular edema (DME) is the accumulation of fluid between the outer plexiform layer and the inner nuclear layer of the retina, resulting in visual impairment. Systemic factors such as high-sensitivity c-reactive protein, homocysteine and creatinine can identify refractory dme early; Intraocular inflammatory mediators and cytokines, such as interleukin and monocyte chemoattractant factor, provide new ideas for the treatment of refractory DME As well as OCT, OCTA and other imaging markers can provide a reference for the judgment of prognosis.

Key words: Refractory diabetic macular edema, Diabetic retinopathy, Pathogenesis