[Intraoperative OCT (iOCT)/microscope-integrated OCT (MI-OCT) in anterior segment diagnostics and surgical treatment]

The surgical options for pathologies of the anterior segment have greatly improved over the last decades, while at the same time the surgical procedures have become increasingly more complex. While penetrating keratoplasty was first established at the beginning of the twentieth century, today there is already a variety of lamellar keratoplasty techniques available. Intraoperative optical coherence tomography/microscope-integrated OCT technology (IOCT/MI-OCT) can assist surgeons in the precise placement of incisions and sutures, thereby helping to optimize the surgical outcome. For example, it enables more precise implementation of the "big bubble" technique in deep anterior lamellar keratoplasty (DALK) surgery, facilitates the correct unfolding and alignment of the Descemet membrane endothelial keratoplasty (DMEK) lamella in cases of severe corneal edema and enables more precise tissue removal during lamellar and phototherapeutic keratectomy. Particularly in neonates and infants, whose examination with a slit lamp is difficult, IOCT is crucial to make a correct diagnosis and thus perform a targeted surgical procedure. Even if the ADVICE study did not show any economic advantage in using IOCT for regular DMEK operations, an increase in surgical efficiency and in particular improved training of prospective ophthalmological surgeons can be observed.