ESCRS 2026: Intraoperative OCT sharpens precision in deep sclerectomy and MIGS procedures, study finds

Intraoperative optical coherence tomography (OCT) added clinically useful detail during glaucoma filtration surgery and micro-invasive glaucoma surgery (MIGS), most notably for measuring precise surgical distances in real time, according to a study presented at the 44th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) in London.

Study design

Ana Miguel, MD, PhD, FEBO, FEBO-G, GCSRT, an ophthalmologist practising in France, and colleagues reviewed 382 consecutive glaucoma surgeries performed between January and December 2024. Intraoperative OCT was used in 41 of these procedures. The investigators then prospectively evaluated the utility of intraoperative OCT across this subset, including cases performed by residents.

Key findings

Intraoperative OCT was most useful during deep sclerectomy, where it allowed precise measurement of the depth of the trabeculo-Descemet's window—a detail Miguel said was more valuable than she had anticipated. It also proved useful for measuring the distance between drainage devices, including the Ahmed Glaucoma Valve (New World Medical), the PreserFlo MicroShunt (Santen), and the Xen Gel Stent (AbbVie), and the corneal endothelium, allowing surgeons to adjust device position intraoperatively when needed.

For MIGS procedures without an implant, intraoperative OCT added interesting detail but was not essential to the surgery itself. For implant-based MIGS, it remained useful: the technology allowed precise identification of the iStent (Glaukos), a device only about 360 microns in diameter, and confirmed correct suprachoroidal placement of the iStent Supra (Glaukos). Intraoperative OCT was less critical for experienced surgeons overall but was particularly valuable for residents once they understood how to operate the device.

Clinical implications

Miguel concluded that intraoperative OCT—used with the ZEISS ARTEVO 800 (Carl Zeiss Meditec) in this study—is a valuable adjunct for deep sclerectomy and for confirming drainage device position relative to the corneal endothelium, and is a useful training tool for residents. She recommended further multicentre prospective studies using different intraoperative OCT systems to build on these findings.