**10. Optical Coherence Tomography (OCT) in surgery**

The OCT has revolutionized the clinical management of ophthalmic diseases and promises to be of great help in the surgical rooms. The Prospective Intraoperative and Perioperative Ophthalmic Imaging with Optical Coherence Tomography (PIONEER), a single site multisurgeon prospective is incorporating the OCT to the surgical room because of feasibility, safety, and utility. This study is performed by the Cleveland Clinic. The variables including past ocular history, procedure type, preoperative diagnosis, techniques, and number of imaging sessions are recorded one day before surgery. The structured study follow-up is done after the surgery [25].

The protocol managing for them is next. Disease-specific or procedure-specific imaging protocols (eg. scan type, pattern, density, size, orientation) were outlined for anterior and posterior segment applications. Anterior segment imaging included a 12mm3 , 12mm volu‐ metric cube scan at 0 degree orientation. Posterior segment imaging included a 10 mm3 , 10 mm volumetric cube with 100 B-scans per volume at both 0 and 90 degrees, a 5 - 3 10mm volumetric cube with 7 B-scans per frame for averaging, a total of 175 B-scans per volume at both 0 and 90 degrees, and a 10 mm radial scan with 100 B-scans per volume. The surgeons were provided with guidance for surgical milestones to consider for imaging (e.g., pre-incision, following membrane peeling, following graft placement), but the specific imaging sessions were at the surgeon's discretion. When possible in vitreoretinal cases, scan sequences were obtained in the operating room prior to any surgical manipulation of the area of interest. Following various surgical milestones, scan sequences were performed to allow for comparative data and change analysis. A ''scan'' was defined as a single set of images. A ''scan session'' was defined as a series of scans obtained during a single pause during surgery. Typically, multiple scan sessions were often performed during the surgical procedures. A specific surgical procedure (e.g., Membrane peeling, lamellar keratoplasty) intraoperative OCT feedback form was included as part of the study protocol. This form included questions regarding the impact of the intrao‐ perative OCT on surgical decision making and on how intraoperative OCT may have impacted the understanding of the surgical disease of interest. OCT provides rapid testing that reduces costs, time, and enhances quality care for surgeons and patients [26].
