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A 32-year-old female presented with visual acuity of hand movement close to face, an old inferior rhegmatogenous retinal detachment (RRD), and a large hemorrhagic macular macrocyst (HMM) in the right eye. After 2 weeks of successful vitreoretinal surgery, the HMM started decreasing in height and resolved by 3 months. On optical coherence tomography, a zone of hyperreflectivity in the outer retinal layers was evident on resolution of the cyst. At final follow-up, the visual acuity improved to 1/60 only. Though HMM resolved completely after retinal reattachment, alteration and thickening of microarchitecture of the outer retinal layers ensued.

The authors describe a technique to qualitatively analyze the posterior segment during cataract surgery using intraoperative optical coherence tomography (iOCT). Macular iOCT can be done before and after intraocular lens implantation after the media is rendered clear following phacoemulsification. A handheld irrigating planoconcave contact lens is placed over the cornea with the operating microscope in retroillumination mode. After focusing the microscope and upon getting a clear view of the posterior segment, iOCT is switched on, centered at the macula, and focused. This technique enables the surgeon to intraoperatively analyze and document the macular morphology and vitreoretinal interface. Potential uses of this technique include intraoperative decision-making regarding concurrent use of anti-vascular endothelial growth factor agents or steroids in cases with dense cataracts where preoperative OCT is difficult. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:846-847.].

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