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Onishi, Alex C., BA*; Ashraf, Mohammed, FRCOphth*,†; Soetikno, Brian T., BS*,‡,§; Fawzi, Amani A., MD*

doi: 10.1097/IAE.0000000000002179
Original Study: PDF Only

Purpose: To examine the relationship between ischemia and disorganization of the retinal inner layers (DRIL).

Methods: Cross-sectional retrospective study of 20 patients (22 eyes) with diabetic retinopathy presenting to a tertiary academic referral center, who had DRIL on structural optical coherence tomography (OCT) using Spectralis HRA + OCT (Heidelberg Engineering, Heidelberg, Germany) and OCT angiography with XR Avanti (Optovue Inc, Fremont, CA) on the same day. Optical coherence tomography angiography images were further processed to remove flow signal projection artifacts using a software algorithm adapted from recent studies. Retinal capillary perfusion in the superficial capillary plexuses, middle capillary plexuses, and deep capillary plexuses, as well as integrity of the photoreceptor lines on OCT was compared in areas with DRIL to control areas without DRIL in the same eye.

Results: Qualitative assessment of projection-resolved OCT angiography of eyes with DRIL on structural OCT demonstrated significant perfusion deficits compared with adjacent control areas (P < 0.001). Most lesions (85.7%) showed superimposed superficial capillary plexus and/or middle capillary plexus nonperfusion in addition to deep capillary plexus nonflow. Areas of DRIL were significantly associated with photoreceptor disruption (P = 0.035) compared with adjacent DRIL-free areas.

Conclusion: We found that DRIL is associated with multilevel retinal capillary nonperfusion, suggesting an important role for ischemia in this OCT phenotype.

Using projection-resolved optical coherence tomography angiography in eyes with disorganization of the retinal inner layers on structural optical coherence tomography, we show that these areas of disorganization of the retinal inner layer are correlated with multilevel capillary ischemia.

*Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;

Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt;

Department of Biomedical Engineering, Northwestern University, Evanston, Illinois; and

§Medical Scientist Training Program, Northwestern University, Chicago, Illinois.

Reprint requests: Amani A. Fawzi, MD; Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, Suite 440, Chicago, IL 60611; e-mail:

Supported in part by NIH 1DP3DK108248 (A.A.F.) and research instrument support by OptoVue, Inc.

None of the authors has any financial/conflicting interests to disclose.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

© 2019 by Ophthalmic Communications Society, Inc.