# Overcoming Opacity: The Role of Intraoperative OCT in Complex Corneal and Anterior Segment Surgery

## TL;DR

Intraoperative OCT helps surgeons perform complex eye surgeries more safely and accurately by providing real-time imaging through cloudy or damaged corneas.

## Contribution

This review highlights the novel application of intraoperative OCT in various anterior segment surgeries with limited visibility.

## Key findings

- iOCT improves precision in endothelial keratoplasty by confirming graft orientation and interface fluid resolution.
- In DALK, iOCT aids in cannula placement and stromal depth assessment.
- iOCT enhances safety during hydrops management and traumatic corneal injury repair.

## Abstract

Intraoperative optical coherence tomography (iOCT) has emerged as a pivotal technology in anterior segment surgery, particularly in cases limited by corneal opacity, edema, or altered anatomy. By providing real-time, cross-sectional imaging, iOCT enables surgeons to visualize otherwise hidden structures and to perform critical intraocular maneuvers with greater precision and safety. Its integration into the surgical microscope allows continuous monitoring of tissue–instrument interaction, transforming traditionally “blind” procedures into image-guided interventions. This review highlights the role of iOCT in endothelial keratoplasty, deep anterior lamellar keratoplasty (DALK), management of acute corneal hydrops, synechiolysis, glaucoma drainage device implantation, and ocular trauma. In endothelial procedures, iOCT helps confirm Descemet membrane removal, graft orientation, and resolution of interface fluid. In DALK, it facilitates accurate cannula placement, stromal depth assessment, and evaluation of leucoma extension to guide surgical strategy. During hydrops management, iOCT supports precise air/gas injection and compression suture placement. Additionally, it enhances safety in synechiolysis, shunt implantation, and repair of traumatic corneal injuries.