Swept-source intraoperative optical coherence tomography for real-time detection of anterior segment membranes during cataract surgery: a case series

Background: Visualization of delicate membranous structures during cataract surgery is often limited under conventional surgical microscopes, particularly when tissues are transparent or obscured. This study aimed to evaluate the intraoperative visualization of delicate membranous structures during cataract surgery using swept-source intraoperative optical coherence tomography (SS-iOCT). Methods: This retrospective observational case series was conducted at the ophthalmology center of a Grade-A tertiary hospital in China. Six eyes of six patients [mean age, 55.3 years; 5 males (83.3%)] undergoing cataract surgery were included in the case series. The cases included Descemet’s membrane detachment, cataract with exfoliative material, traumatic cataract, and age-related cataract. A microscope-integrated SS-iOCT system was used to obtain real-time, depth-resolved, cross-sectional images during surgery. Results: SS-iOCT successfully captured high-resolution images of all eyes (100%), revealing subtle membranous structures undetectable under the surgical microscope. The system delineated fine separation planes, penetrated opaque media to reveal hidden lesions, identified posterior capsule ruptures, and visualized transparent structures, including the anterior hyaloid membrane. In five of the six eyes (83.3%), the intraoperative findings directly influenced the surgical strategy, enabling procedural modifications that enhanced safety and accuracy. Conclusions: SS-iOCT expands the intraoperative field of view, providing real-time recognition of subtle pathological and normal anterior segment membranes beyond the capacity of surgical microscopes. These actionable insights may guide surgical decision-making and support safer, more precise cataract surgery.