Diabetic macular edema (DME) is a vision-threatening complication of diabetic retinopathy resulting from chronic hyperglycemia-induced microvascular damage and increased retinal vascular permeability. Although intravitreal anti-VEGF therapy is the standard management, its long-term response may be variable, highlighting the need for supportive therapeutic approaches. In Ayurveda, DME can be clinically correlated with Pramehajanya Timira, a condition involving vitiation of Kapha and Pitta doshas with secondary involvement of Vata due to Dhatu Kshaya and Raktavaha srotodushti. A 48-year-old female with a 15-year history of type 2 diabetes mellitus presented with progressive, painless diminution of vision in both eyes for four years along with black spots in front of vision for eight months. She had previously received multiple intravitreal injections without satisfactory visual improvement. Fundoscopic examination and optical coherence tomography (OCT) revealed severe non-proliferative diabetic retinopathy (NPDR) with DME in both eyes. The patient was managed with an integrative Ayurvedic treatment protocol over 11 months, including Kriyakalpa procedures such as Nasya, Seka, Tarpana, Putapaka, and Takradhara, along with appropriate internal medications. The treatment was planned to achieve Samprapti-vighatana through dosha pacification, reduction of inflammation, and improvement of retinal microcirculation. Following three treatment sessions, improvement in visual acuity and a significant reduction in central macular thickness, average macular thickness, and total macular volume on OCT were observed. No adverse events were reported. This case suggests that Ayurvedic ocular therapies may serve as a supportive approach in the management of diabetic macular edema.