Disorganized Retinal Inner Layer associated with resolved Diabetic Macular Edema

These OCT images come from the left eye of a 63-year-old male patient with diabetic retinopathy. The feature that they display is Disorganized Retinal Inner Layer (DRIL). The green brackets highlight areas where the retinal layers have less definable boundaries than normal. Compare the definition of the layers from a normal macula (inset, red bracket). Additionally, the patient lost some of his ellipsoid zone in the left eye from the effect of a subretinal hemorrhage many years previous to these images (yellow arrow). The damaged ellipsoid zone, a layer reflecting photoreceptor health, explains the worse visual acuity in his left eye compared to his right eye (20/20 OD and CF @ Face OS). Disorganization of Retinal Inner Layers (DRIL) is a condition in which the layers of a normal retina become can no longer be demarcated on an OCT. The layers affected are the ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), and outer plexiform layer (OPL). This condition may be associated with worsening visual acuity. It can be seen in diabetic retinopathy, retinal vein occlusion, or any other retinopathy associated with ischemia.