Characterization of Peripheral Retinal Degenerations and Rhegmatogenous Lesions Using Ultra-Widefield Swept Source OCT Integrated with a Novel Scanning Laser Ophthalmoscope

<b>Background/Objectives</b>: The purpose of this study was to evaluate the implementation of ultra-widefield swept-source optical coherence tomography (SS-OCT) in characterizing peripheral retinal degenerations and rhegmatogenous lesions, and to assess its potential implications for clinical management. These lesions are often challenging to visualize with conventional techniques, highlighting the need for advanced imaging modalities to improve detection and characterization. <b>Methods</b>: We conducted a retrospective observational study involving patients diagnosed with peripheral retinal degenerations and/or rhegmatogenous lesions referred to our center. All participants underwent comprehensive ophthalmological evaluation, including slit-lamp biomicroscopy, dilated fundus examination, and peripheral SS-OCT imaging. Key parameters assessed included the presence of vitreoretinal attachment, vitreous traction, full-thickness retinal defects, and subretinal fluid associated with the peripheral lesions under investigation. <b>Results</b>: A total of 107 eyes from 95 patients were included. The mean spherical equivalent was -2.18 ± 2.5 diopters, and mean BCVA was 0.03 ± 0.11. Peripheral SS-OCT imaging successfully captured and characterized 130 retinal lesions, including retinal tears (<i>n</i> = 34), lattice degeneration (<i>n</i> = 25), retinal holes (<i>n</i> = 21), peripheral retinoschisis (<i>n</i> = 17), and schisis/detachment (<i>n</i> = 7). Less commonly observed lesions were snail track degeneration (<i>n</i> = 4), white without pressure (<i>n</i> = 4) microcystic degeneration (<i>n</i> = 2), dialysis (<i>n</i> = 2), condensed vitreous (<i>n</i> = 2), and paving stone degeneration (<i>n</i> = 1). SS-OCT provided high-resolution visualization of the peripheral retina and vitreoretinal interface, revealing findings such as vitreous traction, everted edges in retinal holes, and associated subretinal fluid, some of which were not clinically detectable and, in several cases, directly influenced management decisions. <b>Conclusions</b>: Ultra-widefield SS-OCT significantly enhanced the visualization of peripheral retinal degenerations and rhegmatogenous lesions, providing clinically meaningful details that may influence diagnosis and clinical decision-making.