the ins and Outs of intraoperative OCt

w e all use spectral-domain optical coherence tomography (SD-OCT) as a critical tool in preoperative planning for our most routine surgical cases like macular holes, epiretinal membranes, and vitreomacular traction. After our case is completed, we can see the result with SD-OCT: a closed macular hole, removed epiretinal membrane (ERM), and release of macular traction with foveal relaxation. But what happens during surgical manipulation of the retina and preretinal structures? We can see, en face, with the aid of the surgical microscope, but just as in the pre-OCT era in the clinic, our knowledge of what is happening across and beneath the retinal layers is limited. With each forceps grab or scrape with a diamond-dusted instrument, do you really know what is happening to the retina? The current answer is no. The implication is that either you may not be achieving your surgical goals (ie, incomplete release of traction due to hyloid schisis), or you may be inducing more trauma to the retina than intended, resulting in unexpected visual or anatomic outcomes. In this installment of Break It Down, we review current progress with intraoperative OCT using hand-held and microscopeintegrated technology and hear from some of the leaders and pioneers in the field.