Intraoperative optical coherence tomography (iOCT) enables real-time visualization of ocular structures during surgery and enhances our understanding of intraoperative dynamics. iOCT
aids in decision-making during various anterior segment surgeries, and its efficacy and feasibility in anterior
lamellar keratoplasty and endothelial
keratoplasty is well established. The landmark DISCOVER study observed that iOCT altered the surgeon decision in 38% of cases undergoing
lamellar keratoplasty and provided guidance regarding the need for secondary surgical intervention. iOCT also finds an application in
phacoemulsification wherein it helps to assess corneal incisions, intralenticular pressure, and posterior
capsule integrity during nuclear emulsification. iOCT
aids in the visualization of angle structures during placement of tubes and shunts in
glaucoma surgeries and allows precise creation of partial thickness scleral flaps. In addition, iOCT helps in establishing a diagnosis, as well as provide intraoperative guidance, in pediatric patients who are not cooperative for examination. The role of iOCT in
refractive surgeries and ocular surface disorders is increasingly being evaluated. The limitations of present-day iOCT systems are related to instrument compatibility, automated tracking of the surgical field, and on-table volumetric analysis of the real-time images. Technological advances may facilitate complete integration of OCT in the surgical microscopes for all
surgical procedures.