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Introduction: Diabetic macular edema (DME) is the accumulation of excess fluid in the extracellular space within the retina in the macular area, typically in the inner nuclear, outer plexiform, Henle’s fiber layer, and subretinal space. The risk of development of blindness in diabetics increases by 20–25 times as compared to the normal population. There is no direct correlation of Diabetic Retinopathy in Ayurveda but we find reference in “Netra Prakashika” written by Pujyapada Mahamuni that Netra Roga are caused by Prameha. Material method: Patients were randomly divided into two groups as Group ‘A’ and Group ‘B’ with 30 patients in each group. In Group ‘A’ patients were given Virechana by Trivritta Churna after Deepan Pachana and Snehana and Phaltrikadi Kwath orally. Group ‘B’ patients were given Phaltrikadi Kwath Basti and Phaltrikadi Kwath orally. Assessment was done on subjective criteria like Blurred vision (Vihwal Dristi), Floaters (Makshika Mashak Kesh Jaal Pashyati), Photophobia, scotoma (Tamas Darshan black spot in front of eye), Metamorphopsia or distorted vision (Nasa Akshi Yuktani Vipritani Vikshate).  Objective criteria were visual acuity, fundoscopy, optical coherence tomography (OCT), fundus photography. Result: In Group A, statistically significant relief (p<0.0001) was found in blurred vision (49.75 %), floaters (50.00 %), distance vision (26.47 %), pinhole vision (31.81 %), best corrected visual acuity for distance (1.5 %) and central macular thickness (7.6 %). In Group B, statistically significant relief (p≤0.0001) was found in blurred vision (47.90 %), distance vision (22.00%), pinhole vision (26.92 %), best corrected visual acuity for distance (28.12%) and central macular thickness (3.67 %). In intergroup comparison, Group A showed better results in blurred vision (49.75 %), distance vision (26.47%), pinhole (31.81), near vision (12.5%) and central thickness macular (7.60 %) than Group B. Conclusion: Thus, it can be concluded that Virechana Karma is more effective than Basti therapy in the management of Pramahajanya Timira.

Keywords: Diabetic macular edema, Pramahajanya Timira. Phaltrikadi Kwath, Virechana, Basti