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I have reviewed the full preprint (preprints202603.2051.v1.pdf) in detail. This is a narrative review (not a systematic review) on advanced preoperative imaging biomarkers in macula-off rhegmatogenous retinal detachment (RRD). It focuses on SD-OCT/SS-OCT microstructural features, OCT-A, ultra-widefield (UWF) modalities, adaptive optics OCT (AO-OCT), and artificial intelligence (AI). The authors aim to summarize current evidence on diagnostic/prognostic value and highlight gaps for clinical integration.

Overall, the paper is timely and well-written for a preprint, providing a useful overview of emerging OCT-derived biomarkers (e.g., height of retinal detachment [HRD], intraretinal cystic cavities [ICCs], ellipsoid zone/external limiting membrane [EZ/ELM] integrity, outer retinal corrugations [ORCs], bacillary layer detachment [BALAD], etc.). Table 1 is a helpful quick-reference summary of OCT features and their (often debated) prognostic correlations. However, as a narrative review published on a non-peer-reviewed platform (preprints.org, 25 March 2026), it has several methodological, conceptual, and clinical limitations that reduce its reliability for guiding practice or policy. Below are the key pitfalls and unclear areas, organized by section.

Major issues

• The “Materials and Methods” section (page 2) is extremely brief: databases (PubMed, Google Scholar, Scopus), broad keywords, and inclusion of “case-series, retrospective, prospective studies, randomized clinical trials and meta-analysis.” No PRISMA flow diagram, no date limits, no Boolean operators, no duplicate screening process, and no quality appraisal (e.g., Newcastle-Ottawa Scale, risk-of-bias tools). This opens the door to selection bias—the authors may have cherry-picked supportive studies while downplaying contradictory ones.

• We are not told how many articles were screened, how many were ultimately included/excluded, or the time frame searched. Several references are from 2024–2025 (e.g., Sassen 2025, Vidal-Oliver 2025, Venkatesh 2026), which is appropriate for a March 2026 preprint but raises questions about whether older contradictory data were systematically omitted.

• The review correctly notes that many biomarkers are “debated,” “weakly correlated,” or “require longer studies” (e.g., HRD meta-analysis by Murtaza et al. 2023 found only weak correlation; ICCs mixed; ORUs “debated”; HRPs “independent predictive value…still debated”). Yet the abstract and conclusions still present them as “promising” without quantifying effect sizes, confidence intervals, or number-needed-to-treat implications. This creates a optimistic bias that could mislead readers into over-relying on these parameters preoperatively.

• The paper risks giving the impression that advanced imaging can replace clinical judgment on surgical urgency. In reality, symptom duration and macula-off status remain the dominant drivers of visual outcome (meta-analyses consistently show this). Imaging supplements but does not delay surgery.

Minor issues

• Sections on ORCs/ORUs/ORFs and Martins Melo staging system appear multiple times (pages 4–6). The same points about EZ/ELM and rEZR are restated in the AO-OCT and conclusions sections.

• References are extensive (78 listed) but contain some formatting inconsistencies and future-dated entries that may reflect preprint status rather than errors.

If the authors revise this into a full systematic review/meta-analysis (with PRISMA, risk-of-bias assessment, and GRADE tables), it would be far more robust.

Competing interests

The authors declare that they have no competing interests.

Use of Artificial Intelligence (AI)

The authors declare that they did not use generative AI to come up with new ideas for their review.