Eye (Lond). 2026 Aug;40(12):1914-1919. doi: 10.1038/s41433-026-04608-9.
Summary
UWF photos have limited sensitivity for detecting retinal breaks in preop RRD. Complements but doesn’t replace scleral depressed exam.
Abstract
Background/objectives: To determine the sensitivity of ultra-widefield imaging (UWFI) for detecting retinal breaks in primary rhegmatogenous retinal detachment (RRD) and to evaluate its utility for preoperative localisation.
Subjects/methods: We included adults with primary RRD who underwent PPV and had preoperative UWFI. Intraoperative scleral indentation served as reference standard. Breaks were classified by morphology and by a fovea-centred, right-eye standardised clock-hour system. The primary outcome was causative-break detection on UWFI and quadrant-level sensitivities were secondary.
Results: Among 363 eyes with primary RRD, 9 were excluded for vitreous haemorrhage, leaving 354 eyes for analysis. The causative break was detected on UWFI in 208 eyes (58.8%). All breaks were identified on UWFI in 148 eyes (41.8%). Compared with the not-detected group, the detected group was younger (57.8 ± 9.5 vs 61.3 ± 11.6, P = 0.003), had a higher phakic rate (84.6% vs 78.0%, P = 0.041), and showed a smaller detachment extent (1.88 ± 0.72 vs 2.08 ± 0.87 quadrants, P = 0.025). Horseshoe tears were more common in the detected group (80.3% vs 57.5%, P < 0.001), while round holes were more frequent in the not-detected group (42.5% vs 16.8%, P < 0.001). Overall sensitivity for all breaks was 49.1% (308/627). Detection was highest in the temporal quadrant (69.2%) and lower in the nasal (45.9%), superior (45.2%), and inferior (33.0%) quadrants. Clock-hour analysis peaked at 9 to 10 o’clock and was lowest at 5 to 6 o’clock, indicating better temporal and poorer inferior detection.
Conclusion: UWFI alone has limited sensitivity for detecting retinal breaks in patients undergoing retinal detachment repair. UWFI may complement but not replace scleral indentation in perioperative evaluation.
