Purpose: To evaluate outcomes of submacular surgery to remove massive submacular hard exudates with diabetic macular edema. Design: Retrospective, non-comparative, interventional consecutive case series. Participants: Fifty-six eyes of 40 patients with massive submacular hard exudates with diabetic macular edema. Intervention: Submacular surgery was performed to remove massive submacular hard exudates. Main Outcome Measures: Preoperative and postoperative visual acuities and clinical findings. All patients were followed for more than 1 year postoperatively. Results: The macular hard exudates underlying the fovea almost disappeared, and macular edema remarkably reduced following surgery. Visual acuities ranged from 0.01 to 0.3 before surgery, and from 0.04 to 1.0 after surgery. Visual acuity improved by two lines or more in 45 eyes (80.4%), remained unchanged in 8 eyes (14.3%) and worsened in 3 eyes (5.3%). Visual acuity improved to 0.3 or more in 24 eyes (42.9%). Better postoperative visual acuity (0.3 or better) was related to hemoglobin A1C (HbA1C) and the size of hard exudates. Conclusions: Results showed the efficacy of submacular surgery to remove massive hard exudates with diabetic macular edema, and outcomes were satisfactory. J. Med. Invest. 55: 211-215, August, 2008