Intra-Operative Oct During Glaucoma Surgeries

Intra-operative OCT is widely used in cornea and retinal surgeries. Nevertheless, glaucoma surgeons do not use regularly this technique. We intended to characterize the usefulness of intra-operative OCT (iOCT) during glaucoma surgeries.

We conducted a monocentric retrospective study in our glaucoma service in France. 

We followed Helsinki's Tenets. We obtained videos of all glaucoma surgeries in our center during 2024, in which the iOCT was used, including deep sclerectomy, trabeculectomy, tubes, micro-invasive glaucoma surgeries (MIGS) and micro-invasive bleb surgeries (MIBS). We assessed the utility helping the surgeon performing the surgery and the anatomical detail provided by iOCT.

iOCT was useful to guide the surgeon in establishing a correct trabeculodescemetic window thickness in deep sclerectomy. MIBS surgeries (including XEN, Preserflo and MIMS) were also performed with iOCT, which was useful to identify the distance of the devices to the endothelium. In MIGS surgery, intra-operative OCT allowed the identification of the trabeculotomy of GATT surgery (gonioscopy-assisted transluminal trabeculotomy), the correct intra-canalicular positioning of an Hydrus, and even the identification of the smaller iStents. Nevertheless, iOCT was not useful during the surgery itself. iOCT was less useful for identifying the trabeculostomies of ELIOS, and the microsclerostomy from MIMS (mini-invasive micro-sclerostomy).

iOCT brought anatomical detail in glaucoma surgeries, being useful for residents and novice surgeons, and in deep sclerectomy, tubes, XEN, and Preserflo. Nevertheless, it was time-consuming. Future multi-centered studies will be useful to ascertain its utility in different glaucoma surgeries and techniques.