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This study investigates the anatomical changes at the macula in patients with diabetic macular edema (DME) using Spectral Domain-Ocular Coherence Tomography (SD-OCT), highlighting the significance of SD-OCT in diagnosing and managing DME. The research encompasses the pathophysiological aspects of DME, the role of OCT in its evaluation, and the impact of various risk factors on macular changes. Background: Diabetic Macular Edema (DME) is a leading cause of vision impairment among patients with diabetic retinopathy, characterized by the accumulation of fluid in the macula due to the breakdown of the blood-retinal barrier. The study outlines the clinical and pathophysiological features of DME and emphasizes the importance of early detection and management to prevent vision loss. Spectral Domain-Ocular Coherence Tomography (SD-OCT) offers detailed imaging of retinal layers, making it an indispensable tool in the assessment of DME. Materials and Methods: The study was conducted at the Department of Anatomy along with Dept of Ophthalmology, S.M.S Hospital and Medical College, Jaipur, with a sample size of 100 eyes from treatment-naive patients with DME. Inclusion criteria were clearly defined to ensure the study's integrity. SD-OCT (Topcon 3D OCT 2000) was used to measure central macular thickness, the presence of intra-retinal cystoid spaces, and the integrity of the outer retinal layer at the fovea, among other parameters. Results: The study found significant anatomical changes in the macula among patients with DME, including increased central macular thickness and the presence of intra-retinal cystoid spaces. The average central macular thickness was found to be significantly higher in patients with DME, indicating the severity of macular edema. The integrity of the outer retinal layer at the fovea was compromised in a significant number of cases, correlating with decreased visual acuity. Conclusion: The findings underscore the utility of SD-OCT in the comprehensive assessment of DME, providing essential insights into the anatomical alterations at the macula. Early detection and accurate evaluation of macular changes using SDOCT can guide the management and treatment of DME, potentially improving visual outcomes for patients. The study also suggests the need for further research to explore the implications of these anatomical changes on the prognosis of DME. [ABSTRACT FROM AUTHOR]