a 72-year - old female patient with corneal edema due to fuchs corneal dystrophy , after 2 years , uneventful phacoemulsification surgery with intraocular lens implantation was scheduled for dsaek . the following eye had visual acuity of 20/25 ( correction + 1,0 dsph ) and underwent descemet 's stripping endothelial keratoplasty ( dsek ) combined with phacoemulsification surgery 3 years earlier . spectral - domain optical coherence tomography ( sd oct ) examination revealed corneal edema with descemet membrane folds on posterior corneal surface and fluid spaces under the corneal epithelium . the donor cornea was dissected with a moria microkeratome ( 350 m keratome plate ) . after fashioning the clear corneal incision , the surgery was discontinued and the optical coherence tomography ( oct ) exam with commercially available sd oct device ( ivue ; optovue , fremont ; usa ) was performed . acquiring of the image was gained by pressing the foot pedal after focusing the anterior eye segment structures within the oct scan [ fig . 1 ] . after making sure that all of descemet membrane was removed , the air was injected into the anterior chamber with following eye surface sweeping in order to remove fluid from the graft interface . the graft seemed to be attached when analyzing in the surgical microscope . after performing sd oct , multiple fluid micro - spaces were revealed in the area of the graft interface [ fig . 2 ] . due to that , we performed corneal stab incisions in the four main clock hours . after incisions , sd oct revealed a proper graft adhesion to the posterior corneal surface [ fig . 3 ] . at the end of the surgery , the whole procedure lasted for 35 min , which increased the time of the surgery by approximately 15 min . there is a border on posterior corneal surface with and without descemet membrane spectral - domain optical coherence tomography scan performed after donor disc implantation . there is an inaccurate adhesion of a graft with accompanying fluid spaces noticeable spectral - domain optical coherence tomography scan performed after corneal stab incisions with a surface sweeping . assessment of the intraoperative donor disc attachment could be performed routinely with the use of a slit - lamp attached to the surgical microscope or alternatively by observing the donor lenticule border using very high microscope magnification . however , none of those methods gives such a certainty of proper graft attachment as performing intraoperative oct . intraoperative oct analysis by revealing the residual interface space has a potential to reduce the post - operative disc dislocation rate . optical coherence tomography is a high speed , high resolution , non - contact optical imaging technique developed for noninvasive cross - sectional imaging in biologic systems . after dsek surgery , oct was used to monitor cornea and graft morphometric dynamics and its influence on refractive changes after the surgery . the first paper describing the use of handhold oct ( bioptigen sd oct ) during the dsaek to assess the donor - host interface was published in 2010 . this is the first report presenting the intraoperative commercially available oct device . in our opinion , there are two main problems regarding the intraoperative use of oct : the surgery during the sd oct exam is interrupted and there is a necessity of the use additional surgical drapes to prevent the possible touching of the operating field . this inconvenience could be removed by using c - arm allowing the oct exam in the controlled manner . the ideal way would be to use integrated oct and surgical microscope , similar to those used in the vitreoretinal surgery . to conclude : oct assisted dsek allows the assessment of the accuracy of the descemet stripping and donor disc attachment .