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To determine the association between reflectivity levels in foveal cystoid spaces on optical coherence tomography images and the course of the logarithm of the minimum angle of resolution (logMAR) after triamcinolone acetonide treatment for diabetic macular edema.We retrospectively reviewed 58 consecutive eyes treated with an intravitreal or sub-Tenon's injection of triamcinolone acetonide for diabetic macular edema. The foveal cystoid spaces within central 1 mm were circumscribed, followed by measurement of optical coherence tomography reflectivity. The correlation between the reflectivity and visual outcome was investigated.The optical coherence tomography reflectivity levels in foveal cystoid spaces increased at 1 month after treatment, but not at 3 months or 6 months. The preoperative reflectivity levels were correlated negatively with logMAR changes from 1 month to 6 months and from 3 months to 6 months but not with logMAR at individual time points compared with the preoperative logMAR. The changes in foveal thickness from 1 month to 6 months were correlated negatively with the baseline reflectivity and positively with logMAR changes from 1 month to 6 months and from 3 months to 6 months.Lower optical coherence tomography reflectivity in foveal cystoid spaces was associated with the rebound in macular thickening and visual deterioration after triamcinolone acetonide treatment for diabetic macular edema.