The role and clinical significance of intraoperative optical coherence tomography for cataract surgery

Purpose: to evaluate the clinical significance of intraoperative spectral domain optical coherence tomography (iOCT) in cataract surgery with implantation of different types of intraocular lenses (IOL). Methods: In this retrospective observational study, the iOCT image data of 151 cataract cases with different types of implanted IOLs were analysed. For intraoperative imaging a Rescan® 700 was used and the following image criteria were traced: standard surgical steps, IOL optic position, IOL haptic position. Patient eyes were divided into: group 1: n = 101 eyes with lens‐in‐bag (LIB); group 2: n = 15 eyes with bag‐in‐the‐lens IOL (BIL); group 3: 5 eyes with iris‐claw IOL (ICL); group 4: 15 eyes with intrascleral fixated 3‐piece IOL (3‐IOL); group 5: 15 eyes with intrascleral fixated Carlevale IOL (C‐IOL). The data were post‐processed and evaluated statistically. Results: iOCT enabled an additional control of subsequent surgical steps in all studied cases: LIB: the completeness of hydrodissection and hydrodelineation, condition of hydrated paracentesis (in 11% of cases ‐ an incomplete adaptation of paracentesis); BIL: separation of anterior hyaloid and correct implantation of capsular edges into the IOL; ICL: thickness of the iris fold between IOL claws; 3‐IOL/C‐IOL: the position of optic with regard to the iris and position of the haptic in the intrascleral space. Conclusions: The application of iOCT assisted cataract surgery with different IOLs generates useful live data that potentially reduce the risks of intra‐ and postoperative complications (posterior capsule rupture, hypotony, etc.). It can confirm the correct positioning of alternative IOL types intraoperatively, which is crucial to facilitate an optimal IOL performance. The use of iOCT shall be considered during learning process in cataract surgery.