Background: Diabetic macular edema (DME) affect vision greatly in diabetic populations. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) are non-invasive technology to have a cross-sectional image of the retina.

Purpose: to assess anatomy and ischemia that may occur post. Macular laser treatment for DME using OCT and OCTA and its relation with BCVA.

Methods: prospective, observational, cohort study with a total 40 eyes were evaluated with OCT and OCTA before and after macular grid laser used in patients with non- central involving diabetic macular edema.

Results: There was highly significant improvement in BCVA (p <0.0001). There was significant reduction of macular thickness (p<0.0001). There is high relation between IS-OS integrity, DRIL and BCVA. There was significant enlargement of foveal avascular zone (FAZ) post. Laser (p =0.001). Vascular density in superficial capillary plexus decreased (statistically significant) when we compare before and after laser and during period 1&3months of follow-up. Vascular density in deep capillary plexus was statistically significant (reduction) (p<0.0001) before and after laser treatment and at 1&3 months of follow-up.

Conclusion: macular grid laser is an influential treatment for diabetic macular edema with relative ischemia and mild effect on macular perfusion. Anatomical and functional factors other than central macular thickness are also related to best corrected visual acuity.

OCT and OCTA are very helpful during follow -up cases with DME to assess macular thickness, inner and outer retinal integrity, degree of macular ischemia and any complication as ERM that may result from laser.