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Comparison of B-Scan ultrasonography, ultra-widefield fundus imaging, and indirect ophthalmoscopy in detecting retinal breaks in cataractous eyes



To evaluate the diagnostic performance of B-scan kinetic ultrasonography (USG), standard ultra-widefield (UWF) imaging, and indirect ophthalmoscopy (IDO) in retinal break detection in cataractous eyes.


We consecutively enrolled 126 cataract patients (including 246 eyes) with no comorbidities that could decrease best corrected visual acuity (BCVA). Three index tests (USG, nonmydriatic UWF, and mydriatic IDO) were performed preoperatively to screen for retinal breaks. One week after cataract extraction, a dilated IDO examination was repeated for the definitive diagnosis of retinal break as the reference standard. The sensitivity, specificity, Youden index (YI), and predictive values of each index test were calculated according to postoperative ophthalmoscopic findings. A deep-learning nomogram was developed to quantify the risk of retinal break presence using patients’ baseline data and findings reported from preoperative ophthalmic tests.


Fifty-two eyes (21%) were excluded from appropriate preoperative UWF imaging because of massive lens opacity. The BCVA cutoff point with maximum YI indicating UWF applicability was 0.6 logMAR (YI = 0.3; area under curve [AUC] = 0.7). Among all 246 eyes, preoperative IDO, USG, and UWF showed fair interobserver agreement (all κ > 0.2). According to postoperative IDO findings, the index tests with the highest sensitivity and specificity were USG (100%) and preoperative IDO (99%), respectively.


For cataractous eyes without vision-impairing comorbidities, a BCVA better than 0.6 logMAR (Snellen acuity, 20/80) allows for appropriate nonmydriatic standard UWF imaging. In a high-volume clinic equipped with skilled ophthalmic examiners, screening with USG followed by directed IDO allows the efficient identification of retinal breaks in cataractous eyes.

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Fig. 1: Receiver operating characteristic (ROC) curve showing the diagnostic performance of preoperative best corrected visual acuity (BCVA) in indicating the applicability of UWF imaging in cataractous eyes.
Fig. 2: A false-positive retinal break was diagnosed by an ultra-widefield (UWF) imaging system.
Fig. 3: A deep learning-based nomogram showing the risk factors for retinal break presence in cataractous eyes.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.


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National Natural Science Foundation of China (NSFC 81300747, NSFC 82101103, and NSFC 82101087), General Program of Shanghai Municipal Natural Science Foundation (Research Project of Science and Technology Commission of Shanghai Municipality (19ZR1408600 and 22ZR1410400)), Young Clinical Scientist Training Program, Shanghai Medical College, Fudan University (2023, DGF828019–2/038), Excellent Young Doctor Training Program of Shanghai, Shanghai Municipal Health Commission (2015–2018).

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AM, YXJ, and TYZ were responsible for designing the protocol, writing the protocol and report, conducting the search, extracting and analyzing data, interpreting results, updating reference lists, and creating “Summary of findings” tables. PML, YXJ, and YL were responsible for designing the protocol, writing the report, extracting, and analyzing the data, and interpreting the results. LLN and KW built the nomogram and contributed to the design of the protocol, writing the report, extracting, and analyzing data, and interpreting results. YMS, JX, and DJQ contributed to data extraction and provided feedback on the report.

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Correspondence to Yongxiang Jiang or Tianyu Zheng.

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Miao, A., Xu, J., Wei, K. et al. Comparison of B-Scan ultrasonography, ultra-widefield fundus imaging, and indirect ophthalmoscopy in detecting retinal breaks in cataractous eyes. Eye (2024).

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