Background <p>To evaluate the surgical results of scleral buckling (SB) combined with a noncontact wide-angle viewing system with a cannula-based 25G endo-illumination for the management of rhegmatogenous retinal detachments (RRDs) with subretinal proliferation, as well as undetected retinal breaks, in young adults, to explore characteristics of the undetected breaks.</p> Methods <p>The medical records of 26 young RRD patients with undetected retinal breaks and subretinal proliferations who underwent encircling using an SB combined noncontact wide-angle viewing system with a cannula-based 25G endo-illumination were assessed, as were their follow-ups at 1 and 6 months after surgery.</p> Results <p>Retinal breaks were found and treated in 24 (92.3%) of the patients. The breaks were mainly located in the inferior quadrant (66.7%) in the break-detected patients, especially in the inferotemporal quadrant (58.3%). The anatomical successes were 76.9% (20/26 patients) at day 1, 88.5% (23/26 patients) at 1 month, and 100% (26/26 patients) at 6 months after surgery. All patients achieved visual acuity improvements at 6 months (0.39 ± 0.18 logMAR units) after surgery, when compared with their perioperative visual acuities (0.75 ± 0.48 logMAR units).</p> Conclusions <p>In this series, endo-illumination-assisted SB appeared feasible for managing chronic RRDs with undetected breaks and subretinal proliferations. Attention to the inferior quadrant, especially in the inferotemporal quadrant during surgery, may be helpful in treating patients with undetected breaks.</p>