ABSTRACT Lamellar keratoplasty techniques have transformed corneal surgery by enabling selective replacement of diseased layers while preserving healthy tissue, resulting in superior visual outcomes and fewer complications compared with penetrating keratoplasty. However, these procedures are technically demanding due to poor intraoperative visualization of transparent tissue planes. Microscope-integrated optical coherence tomography (MiOCT) has emerged as a major technological advancement by providing real-time, high-resolution, depth-resolved imaging during surgery. MiOCT allows continuous intraoperative assessment of corneal microstructures, enabling precise depth control, confirmation of tissue planes, and immediate detection of complications. Its utility spans surgical planning, intraoperative guidance, and postoperative management in procedures such as deep anterior lamellar keratoplasty, endothelial keratoplasty, refractive surgery, and complex ocular surface procedures. By correlating surgical manoeuvres with objective structural feedback, MiOCT enhances surgical safety, improves outcomes, and shortens the learning curve for advanced lamellar techniques. Despite cost-related limitations, ongoing technological advances are likely to make MiOCT an integral component of modern corneal surgical practice and training.
Prafulla K. Maharana (Thu,) studied this question.