The advent of integrated intraoperative optical coherence tomography (i2OCT) has opened the door for safer and more complex surgeries in the retina and cornea. However, to limit its use to just two subspecialties within ophthalmology is an opportunity lost for many other subspecialties. Here, we describe the use of i2OCT in pediatric cataract surgery in circumstances that are not traditionally considered for i2OCT use. The specific circumstances include: evaluation and treatment of a child following cataract extraction with lens implantation who has failed two attempts at YAG capsulotomy; lysis of post-trauma keratolenticular adhesion in an opaque cornea; surgical removal of secondary lens epithelial cell proliferation after pediatric cataract extraction with lens implantation, and identification of posterior capsular openings and defects. In each case the use of i2OCT allowed the procedure to be completed safely and successfully or informed the surgeon, allowing modification of the surgical decision tree.

Intraoperative portable handheld and microscope-integrated OCT enhance the pediatric vitreoretinal surgeon's diagnostic abilities during examination under anesthesia and surgery, particularly in children who are challenging to examine preoperatively due to young age or ocular trauma. Improved OCT-guided visualization of vitreoretinal anatomic relationships has the potential to improve surgical safety and efficiency. In retinopathy of prematurity and other pediatric retinal vascular conditions, intraoperative OCT can be critical for distinguishing between retinoschisis and retinal detachment and highlighting abnormalities of the vitreoretinal interface that may contribute to development of tractional retinal detachments. During retinal detachment repair, intraoperative OCT aids identification of subtle retinal breaks, residual subretinal fluid, retained perfluorocarbon, preretinal membranes, and residual hyaloid, among other findings. In macular surgery, intraoperative OCT has demonstrated value in confirming completion or lack thereof of epiretinal and internal limiting membrane peeling and differentiating between lamellar and full-thickness macular holes. OCT-guided subretinal bleb formation and genetic vector delivery are critical to ensuring accurate localization of subretinal gene delivery for inherited retinal degenerations. Research on development of OCT-compatible surgical instruments, real-time three-dimensional volumetric OCT imaging, and integration with intraoperative OCT angiography are anticipated to further increase the utility of intraoperative OCT in pediatric vitreoretinal surgical decision-making.

The advent of integrated intraoperative optical coherence tomography (i2OCT) has opened the door for safer and more complex surgeries in the retina and cornea. However, to limit its use to just two subspecialties within ophthalmology is an opportunity lost for many other subspecialties. Here, we describe the use of i2OCT in oculoplastic surgery. It can be used in cases of severe symblepharon where the cornea is heavily involved, so that the surgeon is aware of the depth of the pannus when trying to remove it. It can also be used when the corneal planes are difficult to identify. In oculoplastic surgery the technology allows for identification of tissue planes when en face visualization is difficult due to developmental abnormalities and repeated surgeries. Our experience reflects some of the many uses of iOCT in ophthalmic surgery, highlighting its added value in surgical precision.

The advent of integrated intraoperative ocular coherence tomography (i2OCT) has opened the door for safer more complex surgeries of the retina and cornea. However, to limit its use to just two subspecialties within ophthalmology is an opportunity lost for many other subspecialties. Here, we describe the use of i2OCT in strabismus surgery. It can be used to identify extraocular muscles, especially in cases of strabismus reoperations, thereby augmenting the surgical technique. Its use to help train strabismus surgery is invaluable, allowing the trainee to understand the depth of the scleral pass during strabismus surgery. The authors describe these scenarios of training and augmenting the surgical technique.

The relationship between the anterior vitreous interface and the posterior capsule has received increasing attention in the past decade. The advent of integrated intraoperative optical coherence tomography has allowed a real-time opportunity to grasp this dynamic understanding. Here we describe the normal anatomy of this interface in children and then demonstrate the variation in this interface with different forms of pediatric cataract, namely a posterior plaque and posterior capsular opacity due to abnormal adherence to the vitreous face. The authors describe these changes using meticulous annotation. An understanding of these differences will aid the surgeon in managing pediatric cataracts in a more confident and safe manner.

Integrated intraoperative anterior segment optical coherence tomography is an extremely valuable tool that can be used by corneal surgeons when performing pediatric lamellar corneal transplant surgery. This chapter will demonstrate its use in infants and children with a variety of corneal diseases. These diseases include congenital corneal opacities such as Peters' anomaly (both types I and II), surgical management of limbal dermoids, and its use in selective corneal transplant surgery such as DALK (deep anterior lamellar keratoplasty) or DSEK (Descemet stripping endothelial keratoplasty). These techniques could be used in children with anterior corneal scarring or storage disorders, such as mucopolysaccharidoses, or posterior endothelial disease, such as congenital hereditary endothelial dystrophy or posterior polymorphous dystrophy. This chapter will demonstrate the author's experience using this device during anterior segment corneal surgery.

The advent of integrated intraoperative optical coherence tomography (i2OCT) has opened the door for safer and more complex surgeries in the retina and cornea. However, to limit its use to just two subspecialties within ophthalmology is an opportunity lost for many other subspecialties. Here, we describe the use of i2OCT in pediatric glaucoma surgery. It can be used to identify Schlemm's canal, Barkan's membrane, demonstrate the corneal pathology in Haab's striae, and iris hypoplasia in cases of Axenfeld-Rieger anomaly. It can help identify drainage blebs that are filtering and those that are not, and identify successful drainage tube flushing. It has also been used to identify a ligating suture effect on a drainage tube. We describe these scenarios in relation to training and augmenting surgical techniques.

Diabetic macular edema (DME), defined as a retinal thickening involving or approaching the center of the macula, represents the most common cause of vision loss in patients affected by diabetes mellitus. In the last few years, many diagnostic tools have proven to be useful in the detection and the monitoring of the features characterizing DME. On the other hand, several therapeutic approaches can now be proposed on the basis of the DME-specific characteristics. The aim of the present chapter is to thoroughly delineate the clinical and morphofunctional characteristics of DME and its current treatment perspectives. The pathogenesis and the course of DME require a complex approach with multidisciplinary intervention both at the systemic and local levels.